TAILIEUCHUNG - Section VI - Drugs Affecting Gastrointestinal Function

The term acid-peptic disorders encompasses a variety of relatively specific medical conditions in which injury by gastric acid (and activated pepsin) is thought to play an important role. These disorders include gastroesophageal reflux disease (GERD), benign "peptic" ulcers of the stomach and duodenum, ulcers secondary to the use of conventional nonsteroidal antiinflammatory drugs (NSAIDs), and ulcers due to the rare Zollinger-Ellison syndrome. | Our knowledge of the pathophysiology of diarrheal diseases is increasing rapidly, especially in conditions such as inflammatory bowel disease. As discussed in this chapter, this growth of knowledge already has led to the development of significant new treatments using a rational pharmacological approach. Future pharmacological developments eventually should lead to the control of most symptoms of IBD. However, specific problems in these patients still will pose major therapeutic challenges, such as the long-term safety of biological agents and the prevention of fibrosis and cancer in patients with long-standing inflammation. While more effective agents for treating constipation also are being developed, progress has been slower because of our limited understanding of normal and colonic motility. Until we have a better understanding of the pathophysiology of colonic function, specific treatment of difficult constipation will remain elusive in most cases. Other disease areas covered in this chapter also are clearly in need of more effective therapy. The advent of minimally invasive surgery has reduced the interest in bile stone dissolution therapy, but pharmacologically induced improvements in bile flow can be beneficial in a variety of cholestatic diseases. Finally, the treatment of painful, chronic pancreatitis remains unsatisfactory with available enzyme formulations that offer modest relief at best. Improvement in treatment will require much research on the pathogenesis of pain in this condition.

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