Symptoms, Pathophysiology and Risk Factors of Peptic Ulcer

Health
1

Peptic ulcer is becoming almost a household word, lots of persons in our communities are complaining of peptic ulcer, I can’t stay without food for up to 11am in morning because I’ve got peptic ulcer and the friend he’s talking to replied yeah me too… with this alarming increase in the numbers of persons having peptic ulcer, it becomes very Paramount to know what causes it , what can lead to it ( risk factors) and most importantly how we can avoid or prevent it ( prophylaxis).

What is peptic ulcer

Peptic ulcer is a break in the superficial epithelium of the stomach or duodenum penetrating into the musculature of the stomach and duodenum resulting in an open sore in linings of the stomach and duodenum…in the layman terms peptic ulcer is a sore in the walls of the stomach or duodenum resulting from a break, abrasion or inflammation of the walls of the stomach or duodenum.

Summary : Peptic ulcer occurs when there is a break in the superficial epithelium of the stomach or duodenal walls resulting in an open sore (https://howtodiscuss.com/t/how-to-get-rid-of-a-sore-throat/14711) in the stomach or duodenum… this sore is most times enhanced by the gastric acid ( HCl) in the stomach.*

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What are the symptoms of peptic ulcer

The most common symptom of peptic ulcer disease is burning pain. This pain is caused by the sore in the stomach walls and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically maybe;

  1. be felt anywhere from the navel (umblicus) up to the xiphoid process of the sternum (breastbone)

  2. Be worse when the stomach in empty.

  3. Flare at night.

  4. Often be temporarily relieved by eating certain foods that buffers stomach acid or by taking medications that reduce the production of stomach acid.

  5. Disappear and then return for a few days or weeks.

Summary
The major Symptom of peptic ulcer disease is burning pain that is usually felt between the upper and middle abdomen, the pain be triggered when certain foods such as spicy foods and certain medications such as NSAIDs (e.g Ibuprofen) are taken.
The pain maybe lessen when certain drugs such as buffers (e.g antacids) are taken.

Symptoms resulting from complications of peptic ulcer

  1. dark blood in stools or stools that are black
    or tarry

  2. nausea or vomiting.

  3. appetite changes

  4. unexplained weight
    https ://howtodiscuss.com/t/how-to-lose-weight-fast/444. loss

  5. vomiting of blood which may appear red.

  6. internal bleeding.

Summary: For promt symptomatic relief of acute ulcer, antacid are given to neutralize stomach acid.

Also foods that buffers stomach acid such as milk can be given for promt symptomatic relief*

What causes peptic ulcer disease ( pathophysiology)

Peptic ulcer occurs when there is a break in the superficial epithelium lining the stomach and upper part of the duodenum. This may be as a result of trauma in the stomach lining, inflammation in the stomach lining or Waring off of the mucous layer that lines the stomach.

The common causes of peptic ulcer disease are;

  1. Helicobacter pylori ( H.pylori) : H. pylori is a bacteria (https://howtodiscuss.com/t/bacteria/12804) that commonly live in the mucous layer that covers and protects the epithelial tissue that lines the stomach and small intestine. Often, H. pylori causes no problem, but under certain condition it can cause inflammation of the stomach inner layer, producing an ulcer.

  2. regular use of non steriodal anti-inflammatory drugs (NSAIDs); Regular use of NSAIDs such as Ibuprofen, Ibex, stabumor etc can cause inflammation in the lining of the stomach and small intestine and this can result peptic ulcer.

  3. drinking alcohol : alcohol (https://howtodiscuss.com/t/blood-alcohol-concentration-bac/9426) can irritate and erode the mucous lining of the stomach and it can also increase the amount of stomach acid that’s produced.

  4. smoking : smoking can also increase the risk of peptic ulcer in people who are infected with H. pylori.

NB : HCl is produced in the stomach naturally to aid the digestion process in the stomach and not to cause ulcer. But when the above mentioned causes of ulcer paves the for an ulcer, the gastric acid (HCl) being corrosive in nature can starts eating away the mucous layer lining the stomach and starts increasing and worsening the ulcer…this is why it is not advisable and sometimes very detrimental for ulcer patients to starve (How to lose weight fast without exercise) for a long time.

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Treatment for peptic ulcer

Treatment for peptic ulcer includes;

  1. antimicrobial agents to kill H. pylori.

  2. medications that blocks acid production and promote healing ( proton pump inhibitors).

  3. antacids which neutralize stomach acids.

  4. anti-muscarinic agents

  5. postagladins

  6. anti-histamine and medication to reduce acid production

  7. medication that protects the linings of the stomach
    Where is your stomach located?.

Summary: Anti-ulcer drugs are usually given in combine regimen, a typical anti-ulcer regimen consist of

  1. antimicrobial agent
    2 anti-histamine and proton pump inhibitors and
  2. postagladins… )this is just an example not a standard)… the regimen is usually dependant on the severity… antacids are given for promt symptomatic
    https ://howtodiscuss.com/t/symptom/12173. relief.*

Refractory ulcers ( ulcers that fails to heal)

Some ulcers may fail to heal with treatment, these are refered to as refractory ulcers. Refractory ulcers may be as a result of;

  1. continous use of NSAIDs which increases the risk for peptic ulcer.
  2. Infections with species of H.pylori that resist antibiotics
  3. not taking medications according to pescription (Pharmaceuticals) or breaking the therapy.
  4. Regular use of tobacco.

NB: treating refractory ulcers involves elimination of the factors leading to it. And also the use of more effective antibiotics (https://howtodiscuss.com/t/antibiotic/8734) be
careful with prolong use of NSAIDs.

Frequently asked questions

Frequently asked questions about Symptoms, Pathophysiology and Risk Factors of Peptic Ulcer

Is acid in the stomach bad?

Gastric acid is not bad, and normally gastric acid does not cause ulcer, it’s only worsen an already existing ulcer due to it’s corrosive nature…in other words something else have to cause the ulcer… when something else causes the ulcer then the gastric acid due to it’s corrosive nature can worsen it.

Why is there acid in our stomach

There is acid in the stomach because the digestive enzymes in the stomach needs to the gastric acid to acivates them and to provide an acidic environment for them which is needed for their action.

Conclusion

Peptic ulcer is an open sore in linings of the stomach and duodenum resulting from a break in the superficial epithelium of stomach mucosal.

The major causes and risk factors of peptic ulcer disease are; the enteric microorganism H.pylori, continuous usage of NSAIDs, severe trauma or injury to the stomach walls, alcohol and smoking. Peptic ulcer disease is usually aggravated by the normal digestive acid (HCl) present in the stomach, hence effective treatment for peptic ulcer disease aims at reducing the secretion of gastric acid, eradicating the organism H.pylori and stimulating angiogenesis which speeds up the healing of the ulcerated area.

The best way to prevent refractory ulcer (ulcers that refuse to heal) is to avoid the risk factors such as avoiding long term use of non steriodal anti-inflammatory drugs, alcohol and smoking.

Related articles

2

Peptic Ulcer is a painful disease whose symptoms are severe pain, pathophysiology is yet unknown and associated risk factors are many. I will be addressing Medical Nutrition Therapy (MNT) for Peptic Ulcer and some preventative measures and home remedies.

Peptic Ulcer

Peptic ulcer is the ulceration or sore formation on the inner lining of stomach mainly. It can also occur in duodenum which is first part of small intestines but rarely occur in the lower esophagus. This soreness effects the gastric and muscularis mucosa.

Types of Peptic Ulcer

The different types of peptic ulcers are given below:

1. Gastric Ulcer

It occurs at the age from 50-60 years. It is more prevalent in female population. Stress job might be a causative factor. The pain can radiate to the back. The gastric pain onsets immediately after eating and is aggravated by eating.

2. Duodenal Ulcer

It is more prevalent in people aged between 30-40 years and is more common among male population. It also has stress job as a causative factor, but its onset is 2-3 hours after eating and at the midnight. The symptoms are aggravated by hunger instead of eating. It causes epi-gastric pain and stomach discomfort in the patient.

3. Bleeding Ulcer

The internal bleeding caused by a peptic ulcer if that ulcer has been left untreated for a long time. This is called bleeding ulcer.

4. Refractory Ulcer

A simple peptic ulcer that have not healed after at least 3 months of treatment is called Refractory ulcer.

5. Stress Ulcer

A group of lesions and usually found in the esophagus, the stomach, or the duodenum. Stress Ulcer is normally present in the people who have other illness or are critically ill.

Physiology of Peptic Ulcer

The exact or primary cause of peptic ulcer is still unknown, but it is observed that the digestive enzymes containing the proteolytic enzymes and Hydrochloric acid (HCl) attach the duodenum and stomach wall that causes the injury.

The acidic secretions are more in case of duodenal ulcer than the gastric ulcer. The major symptom is acutes stomach pain when a person is empty stomach.

Possible Secondary Risk Factors of Peptic Ulcer

1 Helicobacter pylori infection
2 Use of Non-Steroid Anti-Inflammatory Drugs (NSAIDS)
3 Excessive excretion of stomach acid after eating
4 Gastric stimulants in diet like coffee, spices, smoking and alcohol
5 Excess stress, can be family stress or stress job
6 Family tendency
7 Zollinger-Ellison Syndrome – recurrent peptic ulcer due to over production of the gastric juices by the body cells
8 Hypercalcemia – a high level of blood calcium causes excess serum gastrin that, as a result, causes ulcer
9 Low serum melatonin – this disturbs the natural sleep-awake cycle, that leads to ulcer

Signs and Symptoms of Peptic Ulcer

1 Burning sensation in stomach
2 Nausea
3 Vomiting
4 Bloating
5 Excessive burping
6 Trouble sleeping
7 Dark colored stool
8 Early satiety
9 Desire to take antacids10 Hunger pangs
11 Unexpected weight loss
12 Indigestion
13 Heartburn
14 Risk factors for peptic ulcer
15 Smoking
16 Alcohol consumption
17 Family history of ulcer
18 Age above 50 years
19 Untreated stress
20 Excess consumption of spicy food
21 Caffeinated drink consumption

Is Gastritis and Peptic Ulcer same thing?

The simple answer is NO. These two are very different medical terms often confused by a lay person.

Occurrence

Gastritis is the inflammation of stomach lining while ulcer occur in the stomach and duodenum, also rarely in esophagus.

Prevalence

Ulcer is more prevalent globally. One in ten people develop ulcer at least once in their life. United States alone reports 5 lac cases of peptic ulcer every year.

Symptoms

These two diseases have over-lapping symptoms. In fact, gastritis can cause the peptic ulcer symptoms.

Causes

Both are triggered by H. pylori, but the symptoms worsen with poor diet, use of Non-Steroid Anti-Inflammatory Drugs (NSAIDS), stress and autoimmune diseases.

Diet Therapy of Peptic Ulcer

Diet Objective

Following are the major objectives of diet therapy in case of peptic ulcer:

1 Avoid foods that trigger gastric secretions
2 Design a diet that helps relief pain
3 Add foods that aid healing of stomach and prevent reoccurrence of disease
4 The quality of food provided must be maintained i.e. hygienic conditions
5 Increase the intervals of feeding
6 Add foods in each meal that inhibit acid production and neutralize the stomach acids
7 Avoid the gastric stimulants and fiber rich food

Dietary modifications

The following modifications are applied to the patient’s diet to enhance individual food tolerance level:

1 Consume meals regularly, avoid skipping meals
2 Add small portion sizes in meal
3 Avoid spicy foods and caffeinated drinks that might act as gastric stimulant
4 Avoid fiber rich foods, vegetables, and whole grain cereals
5 Avoid bedtime snacking or going to bed immediately after consuming meal
6 Avoid drugs that change the stomach lining like aspirin
7 Avoid smoking or drinking on empty stomach

Preferred Food Choices among different Food Groups

1. Cereals and Grains

All types of refined foods are recommended to be added in food. Examples can be white bread, rice, chapati made of refined floor, Sago Dana and rusks etc. these foods are easy to digest and light on stomach.

Whole wheat grains and cereals must be excluded as they increase motility of stomach that leads to gastric irritation.

2. Milk and Milk Products

Milk products can be added in diet as they soothe stomach acidity and contains probiotics.

3. Legumes and Pulses

All the legumes and pulses are allowed in diet but without husk. Also, they must be cooked in low spices.

4. Meat and Meat Products

All moderate and lean meat and its products cooked in low to mild spices are allowed. All the oily, spicy, and fried foods are strictly prohibited as they stimulate the stomach acid.

5. Vegetables

All the starchy and non-starchy foods cooked in low spices are allowed. But spicy vegetables or vegetables in the form of pickles, raw onion with meals or high fiber foods are restricted.

6. Fruits

All the fresh fruits are allowed in diet. But fruits with added spices like fruit chat are prohibited.

7. Dry fruits, Nuts, and Seeds

Fried or salted nuts and seeds are restricted. These foods must be consumed in moderate amount.

8. Fats and Oils

Fats and oils added to cereals like addition of butter to bread or ghee on chapati are allowed but in moderate amount. Oils consumed for cooking must be used in moderation. But avoid excess use of these products.

9. Desserts and Sweets

All the desserts and sweets are allowed for consumption but only in moderation. Excess fatty deserts must also be avoided.

10. Fluids and Drinks

All the fluids and drinks are allowed except carbonated and caffeinated beverages.

Preventive Measures

List of Foods, AVOIDED in Stomach Ulcer

1 Caffeinated drinks like coffee, tea etc.
2 Alcoholic beverages
3 Fried foods
4 Spices and herbs like black pepper, red chilies, and peppermint etc.
5 Chocolate
6 Carbonated beverages
7 Refined sugar
8 Citrus fruits and juices like lemons, oranges, grapefruit etc.

List of Foods, PREFERRED in Stomach Ulcer

1 Green vegetables like cauliflower, cabbage, broccoli etc.
2 Honey
3 Olive oil
4 Green tea
5 Non-starchy low fiber vegetables like carrots, bell peppers and radishes
6 Fruits like apple, avocados, and cherries

Home Remedies for Peptic Ulcer

1. Cabbage juice

Consume half cup of cabbage juice before going to bed. It helps to heal the stomach ulcer and lessens the gastric pain.

2. Honey

Honey acts as antimicrobial and anti-inflammatory. It fights the bacteria and reduces swelling of stomach.

3. Banana

Consuming banana daily or adding it in milk helps reduce the stomach acidity.

4. Fenugreek Leaves

Tea prepared by fenugreek leaves soothes the acidity and stomach pain caused by ulcer.

5. Carrot and Beetroot Juice

Carrots contain vitamin A that helps in warding off stomach ulcer, gastric inflammation, or indigestion.

The beetroot contains nitrates that is converted into nitrites via the bacteria in the mouth and then transforming the nitrites into nitric oxide in the stomach.

Conclusion

Peptic ulcer is the lesion or soreness caused by the pepsin. It is divided into different types based on location or cause of the ulcer. The main cause of ulcer is unknown, but it is aggravated by various factors. There is difference in the occurrence and prevalence of gastritis and peptic ulcer, but they have overlapping symptoms and causes.

The dietary modification is provided for peptic ulcer. One must consume refined grains, less spicy and moderate fat foods. high fiber foods cause gastric motility and bloating. A few home remedies are also provided, so that mild ulcer can be cured at home in time.

If you have ulcer, a modified dietary intake can do wonders in alleviating the pain and discomfort.

3

A peptic ulcer is a common health problem among people. A peptic ulcer is a disease of the gastrointestinal tract that arises when a patient develops an open sore on the lining of the stomach, small intestine, or esophagus. When a peptic ulcer involves the stomach, it is called a gastric ulcer, and the peptic ulcer of the small intestine is called a duodenal ulcer. The ulcer of the esophagus is called an esophageal ulcer.

The symptoms of peptic ulcer include burning pain in the abdomen, loss of appetite, nausea, vomiting, heartburn, and weight loss.

The infection by Helicobacter pylori, the long-term use of NSAID, smoking, any drug’s side effect, cancer of the stomach, and use of alcohol are the causes of peptic ulcer.

The treatment of peptic ulcer depends on the reason causing it. Physicians may prescribe combination therapies that include antibiotics, proton pump inhibitors, and H2 receptor antagonist (acid blocker). To provide symptomatic relief a doctor can prescribe antacids as well.

Peptic ulcers can be avoided by reducing the use of non-steroidal anti-inflammatory drugs and alcohol. Quitting smoking and other narcotics will also help. Avoiding stress and spicy food can also help in prevention.

How to deal with peptic ulcer without medicines

Lifestyle modification

Peptic ulcers can be cured by giving a little bit of attention to your health, diet, and changes in your daily routine. After consulting with your doctor, you can help yourself with your willpower and hard work. If you have a strong determination to get rid of this disease, it is possible by applying a natural approach. This disease is curable. There are so many ways through them you can heal your ulcer.

Avoiding stress

Stress is not the direct cause of the peptic ulcer, but it can exaggerate your illness. When you are in a state of stress, you think more. Your thoughts provoke the release of acid HCL in your stomach that ultimately increases pain in your stomach.

Identify the cause of your stress to handle the situation. Try to ignore irritating things that make you annoy. Strong self-control on your thoughts and emotions and coping with situations will help you deal with your stress. Try to be happy and leave the sad atmosphere.

However, certain conditions that provoke stress are not under your control. Gradually learn to cope with them by involving yourself in some other healthy activities.

Doing exercise

Some exercise plan may enhance your stomach pain. Take care while doing rigorous exercises. These can be uncomfortable for you. Mild to moderate physical activity can be helpful. It can reduce gastric secretions and improver your immune system that helps to reduce the activity of H.pylori. It can help to deal with anxiety.

Meditation

Meditation helps a person to focus and concentrate on a specific poinr, and think positive. Meditation does not have any direct role in the treatment of peptic ulcer, but it can act as a supportive health therapy. Meditation plays a vital role in reducing stress, which ultimately leads to less acid secretions. Due to fewer acid secretion, symptoms like stomach aches, nausea, and vomiting can be avoided. In this way, meditation is helpful for the symptomatic relief of peptic ulcer.

To get enough sleep

Researchers found that poor sleep quality plays an important role in the recurrence of peptic ulcer, and this is a common observation in older patients. The poor sleep triggers the anxiety and stress that can provoke the disease again. It is recommended for an older patient that their sleep problems must be addressed to avoid the recurrence of peptic ulcer.

Avoid negative thinking

Always think positive and remain happy. It will produce a good effect on your health. Negative thinking initiates the anxiety and depression that enhance the feeling of pain in the stomach. Be positive, think good so that you can feel happy and healthy.

Don’t take analgesics regularly

The NSAIDs causes damage to the lining of the stomach and duodenum that leads to the development of ulcer. The presence of acid also exaggerates the condition. The smallest effective dose of NSAIDs should be taken if necessary. The patient who requires these drugs should take extra measures. They can take the medicine during a meal to avoid stomach upset and take other medicines along with painkillers to reduce its side effect like proton pump inhibitors.

Setting a routine

The patient with peptic ulcer disease should set their dietary routine.

Firstly they should not keep their stomach empty for longer periods as the acid can erode their stomach lining. They should take small portions of meals every two hours. It will reduce acid in their stomach, and they will not feel any stomach discomfort or pain.

The second important thing is that the patients should not take their dinner late at night, avoid eating just before going to bed. When you eat food late at night, it will not digest before you fall asleep. This will not only disturb the sleep but also causes heartburn and acidity. It is recommended to make a healthy routine of your eating habits.

Healthy diet

A healthy diet has the most important role in ulcer patients. This disease is related to the stomach. Whatever we eat had direct contact with the stomach and produces its effect immediately. Therefore it is necessary to take special care of your diet. Many food groups provide relief, symptomatic treatment, healing, and beneficial nutrients to ulcer patients.

The food includes yogurt, banana, oatmeals, cereals, milk, honey, garlic, olive oil, turmeric apple, cauliflower, and cabbage. These foods act as antibacterial and antioxidant and provide coating in the stomach.

Food to Avoid

Certain food groups cause stomach upset, erosion, and irritation by increasing the secretions of stomach acid.

The food and beverages that should be avoided include

  • Alcohol
  • Pepper
  • Caffeine
  • Tea
  • Spicy food
  • Citrus food
  • Carbonated drinks
  • Tomato
  • Chocolate
  • Deep-fried food.
  • Food having a high content of salt

Herbal Treatment

There are many herbal treatments available. They are natural remedies with no side effects. A qualified herbalist can provide the best remedy to deal with peptic ulcer. These treatments can be used along with regular medicine safely. Most of the research shows that in some specific conditions, herbal medicines are found more effective than the drugs used in peptic ulcer. They can be an important alternative therapy for those patients who can’t tolerate the adverse effects of the drugs.

Protect yourself from H. pylori

By regular washing your hands, eating clean, and well-cooked food, you can protect yourself with H.pylori. Drink clean water.

4

Peptic ulcer is a erosion in the lining of the stomach and duodenum.It’s commonly caused by helicobacter pylori or regular use of non steriodal anti-inflammatories (NSAID).

SITE OF OCCURRENCE :
• It most commonly occurs in the pyloric region of stomach known as gastric ulcers.
•second most common site is the first part of duodenum know as duodenal ulcers.

SYMPTOMS OF PEPTIC ULCER :
•epigastric pain.
•abdominal indigestion .
•loss of apetite.
•nausea,vomiting.
•weightloss.

CAUSES:

•Use of NSAIDs(non steroidal anti-inflammatory drugs)
• Helicobacter pylori.
•Increased hydrochloric acid secretion.
• Inadequate mucosal defence against gastric action.

TREATMENT APPROACHES :

•Eradication of H.pylori infections.
•Reducing the secretion of gastric acids with use of PPIs or H2-receptor antagonist.
•Providing agents that protects gastric musoca from damage.

DRUGS USED TO TREAT PEPTIC ULCERS:

A- Antimicrobial agents:

Patients with peptic ulcers who are infected with H.pylori are treated with antimicrobial drugs.

•successful eradication is possible by various combination of antimicrobial drugs.

•Currently triple therapyconsisting of PPI combined with Amoxicilin (metronidazol may be used in penicillin-allergic patients) plus clarithromycin is the therapy of choice.

•quadruple therapy of bismuth subsalicylate , metronidazole and tetracycline plus a PPI is another option.

FAQ:

Q-Why single antimicrobial drug is not beneficial for the treatment of peptic ulcer?

ANS :Treatment with a single antimicrobial drug is less efficient and leads to Antimicrobial resistance and is not recommended.

B-H2-receptor ANTAGONIST:

gastric acid secretion is stimulated by histamine, acetylcholine and gastrin. The receptor-mediated binding of of acetylcholine,histamine and gastric activates protein kinase,which in turn stimulates H+/K±adenosine triphosphate (ATPase) proton pump to secrete hydrogen ions in exchange of of K+ into the lumen of stomach by competitively blocking the binding of histamine to H2-receptor.

THE FOUR DRUGS USED AS H2-RECEPTOR ANTAGONIST:
•cimitidine
•ranitidine
•famotidine
•niaztidine

1-ACTIONS:
The histamine H2-receptor antagonist act selectively on H2 receptors in stomach, but they have no effect on H1-receptors.They are competitive antagonist of histamine and are fully reversible.

2-THERAPUTIC USES:
The use of these agents has decreased with advent of PPIs.

a. PEPTIC ULCERS: All four agents are generallyeffective in promoting the healing of duodenal and gastric ulcers however,recurrance is common in H.pylori and is present and the patient is treated with these agents alone.
Patients with NSAID-induced ulcers should be treated with PPIs,because these agents heal and prevent future ulcers more effectively than H2 antagonists do.

b.Acute stress ulcers : These drugs are given as an intravenous infusion to prevent and manage acute stress ulcers associated tolerance may occur with these agents in this setting, PPIs have gained favor for this indication.

c. Gastroesophageal reflux disease (GERD): Low doses of H2 antagonists, currently available for over-the-counter sale, are effective for this treatment of heartburn (GERD) in only about 50% of patients. H2 -receptor antagonists act by stopping acid secretion, Therefore, they may not relieve symptoms for at least 45 minutes. Antacids more quickly and efficiently neutralize stomach acid, but their action is only temporary. For these reasons, PPIs are now used preferentially in the treatment of GERD, especially for patients with severe heartburn.

3.pharmacokinetics:
After ■■■■ administration ,the H2 antagonist distribute widely throughout the body(including ■■■■■■ milk and across the placenta ) and are excreted into urine.
Cimitidine,ranitidine and famotidine are also formulated to be used intravenously. half life of these dugs are increased in patients with renal dysfunction.

4. adverse effects:
In general,the H2 antagonist are well tolerated. Cimitidine can have endocrine effects because it acts as a non-steroidal anti androgen.these effects include gynecomastia and galactorrhea. The other agents does not produce antiandrogenic effects and prolactin-stimulating effects.

cimitidine can inhibits other cytochrome P450 isoenzymes such as warfarin,phenotoin,and clopidogrel.

C- PPIs: inhibitors of H+/k±ATPase proton
pump.

PPIs decrease the Hydrogen ion secretion
into gastric lumen.The available PPIs are
•dexlansoprazole
•esomeprazole
•lansoprazole
•omeprazol
•pantoprazol
•rabeprazol

1-Actions : These drugs are prodrugs with an acid resistant enteric coating to prevent them from ■■■■■■■■■ degeneration by gastir acid.this coating is removed by alkaline duodenum and the prodrug is absorbed into parital cells.This become an active drug and forms a stable covalent bond with H/K-ATPase enzyme. It takes 18 hours for the enzyme to be resynthesized and the acid secretion is inhibited till that time.

2-theraputic use :
PPIs are superior to H2-recepto antagonist and suppresses the acid production and heal the peptic ulcers.

PPIs are used in the therapy of the following diseases
•stress ulcer treatment
•GERD
•prophylaxis
•erosive esophagitis
•active duodenal ulcers

3.pharmacokinetics:

PPIs should be taken 30 mins prior to breakfast or a meal.Esomeprazole,lansoprazole, are present in intravenous formulations.plasma half life of these drugs are small but they have a long duration of action.

4-adverse effects:

All of the PPIs are well tolerable.

OMEPRAZOLE and ESMEPRAZOL may decrease the effectiveness of CLOPIDOGREL because they inhibit CYP2C19 and prevent the conversion of CLOPIDOGREL to it’s active metabolite.

•prolong use of PPIs and acis suppression will lead to vitamin B12 deficiency because acid is required for it’s absorption

•diarrhea and colostridium difficile colitis is commonly seen within the patients using PPIs

•hypomagnesemia

•increased incidence of pneumonia.

D.PROSTAGLANDINS:

prostaglandins stimulates the secretion of muscous and bicarbonates and inhibits the secretion of acid.

MISOPROSTOL, an analog of prostaglandin is used for the treatment of NSAID-induced peptic ulcers,but this drug is not prescribed to pregnant mothers since it induces uterine contractions.

E.ANTACIDS:
These are weak bases which react with acid to form water and a salt followed by a declining gastric acidity.

Commonly used Antacids are
•Aluminium hydroxide
•magnesium hydroxide
•calcium carbonate

2.therapeutic use:
Antacids are used for symptomatic relief of peptic ulcers and GERD.Antacids are supposed to be taken after a meal.

3.Adverse effects :
•Aluminium hydroxide tend to cause constipation.
•magnesium hydroxide tend to produce diarrhea.

F.mucosal protective agents :

these are also know an cytoprotective compunds. they enhance mucosal protection mechanism and prevent mucosal injury.

1.bismuth subsalicylate : it’s a component of quadruple therapy to peptic ulcers.

2.sucralfate: it’s a complex madeup of Aluminium hydroxide and sulfated sucrose which binds to proteins of both normal and injured/necrotic mucosa by forming a complex with the epithelial lining. this forms a protective barrier and protect the ulcers from the action of pepsin and acid and allowing it to heal.

prevention against peptic ulcers :

•avoid the food that irritates your stomach
•drink clean boiled water
•avoid kissing or saliva exchange with someone with H.pylori
•your NSAIDS intake should’nt exceed.
•wash your fruits and vegetables before eating them.
•decrease alcohol consumption.
•eat food such as yoghurt and buttermilk.

SUMMARY : Peptic ulcers disease are caused by gram negative HELICOBACTER PYLORI , the use of NSAIDs ,Increased HCL secretion and inadequate mucosal defense against gastric acid.Treatment includes eradiation of H.pylori , reducing the gastric acid secretion by the use of PPIs or H2-receptor antagonists, providing agents the protects gastric mucosa.Peptic ulcers can be prevented by avoiding contact with an infected person, decreasing consumptions of alcohol, washing fruits and vegetables before consuming them.