Clinical Therapeutics 15. Supplement B [antikvár]

Foreword Gorig Brunner, M.D., Ph.D. Department of Gastroenterology and Hepatology, Hannover Medical University, Oststadt Hospitál, Hannover, Germany The development of proton pump inhibitors has opened a new era in gastroenterology. The ability to block the action of the proton pump makes the physician independent of the different kinds of acid stimulation. Proton pump inhibitors surpass by far the former gold standard of H2-receptor antagonists with respect to pain relief and speed of healing. For the first time dose-related acid control can be achieved according to the needs of the patient and the judgment of the physician. Peptic ulcerations that do not heal with the highest doses of H2-receptor antagonists and that resist extensive surgery can practically all be healed by proton pump inhibitor administration. Surgery is therefore no longer needed for the treatment of uncomplicated peptic disease. Vagotomy and stomach resection as well as fundoplication are methods of the past. Only bleeding peptic ulcerations and pyloric stenosis when not treatable by endoscopic means (sclerotherapy or balloon dilatation) continue to require surgery. However, in the majority of these cases only conservative surgery will be needed, such as oversuturing or pyloroplasty, leaving the anatomy of the upper intestine intact. Maintenance therapy with proton pump inhibitors can then prevent further peptic disease if Helicobacter pylori cannot be eradicated or is not involved in the disease. Even in the new era of H pylori eradication proton pump inhibitors play two important roles. First, they inhibit metabolic pathways of Hpylori, thus slowing down its proliferation, and second, they improve the conditions for many antibiotics through temporary, profound acid reduction. The inhibition of the proton pump is a new, effective strategy in the treatment of acid peptic disease. It is safe in short-term therapy; maintenance therapy for up to 10 years with omeprazole and up to 4 years with lansoprazole appears promising.12 The future will show whether that promise is fulfilled.