Beschreibung
Gastric secretions contain hydrogen ions at a concentration that is more than one million times higher than their intracellular concentration. This phenomenal gradient as well as the demonstrated ability of gastric juice to digest tissues has motivated clinicians and investigators alike to emphasize acid secretion and acid ablation in studying the pathogenesis and therapy of peptic ulcer disease. Conse quently, over the past 150 years, we have made considerable progress in under standing the mechanisms and regulation of acid secretion by the stomach. Not surprisingly, therapy for both peptic disease and mucosal injury has also been predominantly directed at either neutralizing acid or suppressing its production. During the past 10 years, attention has been focused on factors other than acid in the genesis and therapy of ulcer disease. Work done worldwide demon strated that acid hypersecretion is not a common event in peptic ulcer disease. Therefore, we began realizing that factors other than acid secretion may be important in the genesis of ulcer disease or in gastroduodenal mucosal damage. In addition, new physiological information has established that the gas troduodenal mucosa is normally protected by a complex series of events includ ing mucus and bicarbonate secretion, cell renewal, surface mucosal restitution, and preservation of the microvasculature and mucosal proliferative zone.
Autorenporträt
InhaltsangabeI. Cytoprotection for the Clinician.- 1 Cytoprotection: Historical Perspective.- 1. Introduction.- 2. Antiulcer Effect without Acid Inhibition.- 3. Direct Cytoprotection.- 4. Differences among Prostaglandins.- 5. Clinical Studies on Cytoprotection.- 6. Adaptive Cytoprotection.- 7. Functional Cytoprotection.- 8. Intestinal Cytoprotection.- 9. Conclusions.- Annotated Bibliography.- 2 Acid Hypersecretion: Important Factor or Innocent Bystander?.- 1. Introduction.- 2. Information Interpreted as Indicating a Connection between Gastric Juice and Duodenal Ulceration.- 2.1. Animal Studies.- 2.2. Human Studies.- 2.3. Response to Treatment.- 2.4. Relationship between Acid and Pepsin in Gastric Juice.- 3. Analysis of the Evidence for the Role of Gastric Secretion in Ulcerogenesis.- 3.1. Animal Studies.- 3.2. Human Studies.- 3.3. Response to Treatment.- 3.4. Relationship between Acid and Pepsin.- 3.5. Heterogeneity.- 3.6. Mucosal Injury.- 4. Association and Causation.- 4.1. Strength of Association.- 4.2. Consistency of Observed Association.- 4.3. Specificity of Association.- 4.4. Temporality.- 4.5. Plausibility and Coherence.- 4.6. Bias.- 4.7. Summary: Relationship between Putative Cause and Disease.- 5. Alternative Etiologic Bases for Duodenal Ulceration.- Annotated Bibliography.- 3 Pathomorphology of Gastric Mucosal Injury.- 1. Functional Morphology of the Gastric Mucosa.- 2. General Consideration of Cell Injury.- 3. Pathogenesis of Reversible and Irreversible Cell Injuries.- 3.1. Ischemia.- 3.2. FreeRadicals.- 3.3. Cellular Signaling System.- 3.4. Cytoskeleton.- 3.5. Calcium as Ultimate Cell Killer.- 4. Gastric Mucosal Injury.- 4.1. Acutelnjury.- 4.2. Chronic Mucosal Injury - Acetic Acid-Induced Ulcers.- 4.3. Stress-Induced Ulcers.- 4.4. Endogenous Prostaglandins, Thromboxanes, Leukotrienes, and Platelet Activating Factor.- 5. Pathogenesis of Gastric Mucosal Injury.- 6. Relevance to Human Pathology.- Annotated Bibliography.- II Defensive Mechanisms of the Stomach.- 4 Mechanisms of Mucosal Protection.- 1. Introduction.- 2. Anatomical Features of Gastroprotection.- 2.1. Cell and Organelle Membrane Permeability.- 2.2. Cell Migration (Restitution) and Division (Regeneration).- 2.3. Microcirculation.- 2.4. Muscle Tone.- 3. Biochemical Processes Relevant to Protection.- 3.1. Mucus and Bicarbonate Secretion.- 3.2. Hydrophobicity of Phospholipids.- 3.3. AcidSecretion.- 3.4. Fluid Flux.- 3.5. Free Radical Scavenging.- 3.6. Release and Action of Enzymes.- 3.7. Release and Action of Vasoactive Substances.- 4. Mechanisms of Action of Major Groups of Protective Agents.- 4.1. Major Chemical Groups.- 4.2. Individual Drugs.- 5. Summary.- Annotated Bibliography.- 5 Mucus Secretion.- 1. The Nature of the Gastroduodenal Mucus Barrier.- 2. Structure of Mucus and Its Mucin Components.- 3. Mucus and Protection against the Endogenous Aggressors.- 3.1. Acid.- 3.2. Pepsin.- 4. Impairment of the Mucus Barrier in Peptic Ulcer Disease.- 5. Mucus and Protection against Exogenous Damaging Agents.- 6. Mucus Secretion, Cytoprotection, Prostaglandins, and Other Antiulcer Agents.- Annotated Bibliography.- 6 Bicarbonate Secretion and the Alkaline Microclimate.- 1. Introduction.- 2. Bicarbonate Secretion.- 2.1. Historical Background.- 2.2. Measurement of Bicarbonate Secretion.- 2.3. Significance of Bicarbonate Secretion.- 2.4. Mechanisms of Bicarbonate Secretion.- 3. Regulation of Gastroduodenal Bicarbonate Secretion.- 4. Effects of Damaging and Protective Agents on the Alkaline Microclimate.- 4.1. Damaging Agents.- 4.2. Protective Agents.- 5. Importance of the Alkaline Microclimate in the Pathogenesis and Treatment of Peptic Ulcer Disease.- Annotated Bibliography.- 7 Epithelial Cell Renewal.- 1. Introduction.- 2. Epithelial Renewal in the Normal Gastrointestinal Tract.- 2.1. Process of Epithelial Renewal.- 2.2. Epithelial Renewal within the Esophagus, Stomach, and Duodenum.- 2.3. Regulation of Epithelial Renewal.- 2.4. Restitution of the Epithelium.- 3. Methods of Study
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E-Mail: juergen.hartmann@springer.com
