Acid peptic disease includes peptic ulcer “gastric and duodenal”, gastroesophageal reflux and pathological hypersecretory states such as Zollinger - Ellison syndrome.
Gastrointestinal Pathologies
Treatment
- Rapid relief of symptoms
- Healing of ulcer
- Preventing ulcer recurrences
- Reducing ulcer-related complications
- Reduce the morbidity (including the need for endoscopic therapy or surgery)
- Reduce the mortality
General measures:
Important factor subsequent to the medication to achieve therapeutic goal
- rest:
- mental (in some cases we can use minor tranquilizers as diazepam to relieve pain and improve healing)
- physical (rest in bed in case of acute hemorrhage)
- diet
- give small frequent light meals for DU patient (why?) in order to buffer high acidity.
- avoid heavy meal , irritant, spices
- habits:
- Avoid smoking, alcohol, carbonated water , xanthine beverages as coffee, tea, cola)
- drug avoidance:
- (parasympathomimetics , reserpine, xanthenes, all anti-inflammatory drugs (steroids and NSAID) caffeine. morphine, and nicotine (nicotine increases HCl secretion). .KCL, digestants,
Drugs Used For Treatment of Peptic Ulcer
Medications that decrease acid secretion:
- Proton Pump Inhibitors (H+/K+ ATPase inhibitors) Best Most Potent - last resort after combination therapy ⇒ Mono ⇒ PP + Combination
- H2 Receptor Antagonists
- Anticholinergic Drugs
Drugs enhancing mucosal defense mechanisms:
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Antacids (drug raising intragastric pH).
Note… Sucralfate and colloidal bismuth compound are not given simultaneously with antacids or H2-receptor antagonists (at least 30 minutes must be elapsed in-between).
Others:
- CARBENOXOLONE (It is liquorice derivative)
Antimicrobials that are effective in eradication of H. pylori:
- AmoxicillinY,
- Tetracyclines (doxycycline),Y
- Bismuth Subsalicylate,Z
- Metronidazole & clarithromycin.Y
ANTIMICROBIALS USED TO ERADICATE ULCER Suppression of acid secretion will heal the ulcers, but long-term cure requires eradication of H. pylori, if that is the cause of ulcer. Amoxicillin, tetracycline (doxycycline), bismuth subscitrate, metronidazole & clarithromycin.
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Currently, either triple therapy consisting of a PPI with Metronidazole or Amoxicillin or clarithromycin, or
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quadruple therapy of Bismuth Subsalicylate and Metronidazole plus Tetracyclines plus an H2 Receptor Antagonists or a PPI, are administered for a two-week course.
