Pharmacology
Peptic Ulcer Disease
Peptic ulcer disease, is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 70–90% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs.Classification
By Region/Location-
-Duodenum (called duodenal ulcer)
-Esophagus (called esophageal ulcer)
-Stomach (called gastric ulcer)-Meckel's diverticulum (called Meckel's diverticulum ulcer; is very tender with palpation)
Modified Johnson Classification of peptic ulcers:
-Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistantiae.
-Type II: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion.
-Type III: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion.
-Type IV: Proximal gastroesophageal ulcer
Type V: Can occur throughout the stomach. Associated with chronic NSAID use (such as aspirin).
Signs and symptoms
-abdominal pain, classically epigastric with severity relating to mealtimes, after around three hours of taking a meal (duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it)
-bloating and abdominal fullness
-waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus - although this is more associated with gastroesophageal reflux disease)
-nausea, and copious vomiting
-loss of appetite and weight loss
hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
-melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin)
-rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This is extremely painful and requires immediate surgery
Drugs for Peptic Ulcer Disease
A)Acid Neutralizer /Antacids:
1.Sodium Bicarbonate
2.Calcium Bicarbonate
3.Magnesium Hydroxide
4.Aluminium Hydroxide
B)Agent that enhance mucosal resistance:
1.Sucralfate
2.Misoprostol
3.Colloidal Bismuth Compounds.
C.Agent that reduce HCL secretion :
Directly acting:
a)H2 -receptor blocker:
-ranitidine
-cimetidine
-nizatidine
-famotidine
b)Proton pump inhibitor(PPI):
-omeprazole
-esomeprazole
-pantoprazole
-lansoprazole
-rabeprazol
c)Anti Muscarinic drugs:
-Pirenzepine
-Telenzepine
Indirectly Acting :Antibiotics
-metronidazole
-Amoxicilin
-Tetracycline
-Clarithromycin
In case of H.Pylori causing peptic ulcer:
-Triple Therapy or,
-Quadruple Therapy can be used
Triple Therapy x 14 days :twice daily
1.PPI
2.Clarithromycin(500mg)
3.metronidazole (500mg) /Amoxicilin(1grm)/Tetracycline (500mg)
Quadruple Therapy x 14 days:
1.PPI(twice daily) or H2-Receptor Antagonist
2.Metronidazole (500mg)
3.Tetracycline (500mg)
4.Bismuth Subsalicylate (525mg)
Single antibiotic regimens are ineffective in eradicating H.Pylori infection and lead to microbial resistance.So combination therapy with 2 or 3 antibiotic is associated with highest rate of H.Pylori eradication.
by Lakdhes.
Hey thanks for the detailed explanation along with those images. Really helped me to understand the cause of peptic ulcers.
ReplyDeleteYou see, my mother has been suffering from peptic ulcer symptoms for quite sometime now and the doctor has prescribed her with a medicine Nexium 40mg but somehow I am not convinced about its effectiveness.
Can you let me know if it is a same medication to take?
hi rolden..generic drug of nexium is esomeprazole..i'm not sure about the treatment there.but here,in bangladesh ,the doctors follows the triple or quadruple therapy as i mention above for chronic PUD..it was very effective here..but the complication of the therapy also have to be consider..even back in malaysia,the doctors never prescribe omeprazole for PUD..the only give magnesium hydroxide in the liquid form..u can talk with the doctor about triple or quadruple therapy for your mother.they might know better about your mother's actual condition..here,i have seen most of the people who suffered from duodenal ulcer,small intestine n etc were given esomeprazole..those with stomach ulcer ,omeprazole will be a better choice..even the ulcer did not cure fully,but it relieve them from the pain..esomeprazole is a good choice..but there are different brand for a same drugs..from my own experience,i felt that,the drug of choice is not the problem..maybe the brand.some brand works better,some are not..some give unpleasant side effect..so you can ask you doctor for different brand for esomeprazole if you find nexium is not so effective..
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