Drug Scheme for Stomach Ulcer Samples †MyAssignmenthelp.com

Question: Discuss about the Drug Scheme for Stomach Ulcer. Answer: Gastric ulcers or stomach ulcers occur in the form of painful sores in the inner lining of the stomach. They are non-malignant, mucosal lesions in the stomach. Pepsin and gastric acids play important pathogenic roles in their occurrence. Corrosive action of hydrochloric acid and pepsin on the mucosa of upper gastrointestinal tract leads to the formation of such ulcers (Salama, Hartung and Mller 2013). The diameter of these ulcers ranges between 3 mm to several centimetres. The corrosive action reduces the thickness of mucus layer that protects the stomach from digestive juices. This provides an opportunity to the digestive acids to destroy the tissues lining the stomach (Figure 1). About 500,000 new cases of stomach ulcer occur every each year. The mortality rates for peptic ulcer in Australia are estimated to be around 2.1 per 100,000 individuals. Men are twice more likely to get affected by gastric ulcer than women (Barazandeh et al. 2012). Excess secretion of gastric juice is one of the contributing factors. The other major factor is decreased defence of the mucosa against gastric acid. Integrity of the upper gastrointestinal tract depends upon the balance between several hostile factors such as Helicobacter pylori, gastric acid, pepsin, NSAIDs and other protective factors like mucus, prostaglandins, bicarbonate, and flow of blood to the gastrointestinal mucosa. pylori are spiral bacteria that attack the stomach lining. They lead to the production of harsh, acidic environment in the stomach by penetrating the stomach lining. These bacteria generally spread through saliva and faecal contamination of food and water. Genes also play a role in the incidence of the disease. First degree relatives are thrice more likely to get infected. 20-50% patients with gastric ulcer report positive family histories. Increased incidence of the disease cause due to H.pylori infection is observed among people with O positive blood group. Most common symptoms of gastric ulcer are abdominal discomfort, nausea and pain. The pain is generally located in the epigastrium and does not radiate. The most commonly used diagnostic test to evaluate stomach ulcer is upper gastrointestinal endoscopy. Esophagogastroduodenoscopy (EGD) is another accurate method used to diagnose stomach ulcers. Histological examination of H.pylori with standard eosin and hematoxylin staining serves as an excellent diagnostic technique. The drugs that are used in treatment of stomach ulcers either reduce intragastric acidity or promote mucosal defence and eradicate infection by H.pylori. The commonly used drugs are: Antacids- They chemically react with gastric hydrochloric acid and decrease pepsin activity. They are salts like CaCO3, NaHCO3, Mg(OH)2 and Al(OH)3. Antibiotics- These include amoxicillin, metronidazole, tinidazole, tetracycline and levofloxacin, which kills H.pylori. H2-receptor antagonists- They include famotidine, ranitidine and nizatidine and block the action of histamine on the H2 receptor (Laine et al. 2012). Prostaglandins- Orally administered to stimulate mucus and bicarbonate excretion. Bismuth subsalicylate- Coats the ulcers and has antimicrobial activity. Proton pump inhibitors- Omeprazole, pantoprazole and raperazole are commonly used. Proton pump inhibitors (PPIs) irreversibly block the gastric proton pump or the H+/K+ATPase pump of the parietal cells (Figure 2). This pump secretes H+ions into gastric lumen. Therefore, the pumps are considered as an ideal target for inhibition of gastric acid secretion. These classes of drugs are comparatively more effective than H2 receptor antagonists in reducing acid secretion (Alhazzani et al. 2013). When the gastric acids are decreased, stomach ulcers get healed along with a reduction in heartburn and pain. However,protein digestion requires some essential stomach acids. A significant reduction in their amount may lead to hypochlorhydria. PPIs are weak bases that are made up of 2 moieties. A benzimidazole with 1.0 second pKaalong with a substituted pyridine with 4.0 primary pKaforms the major constituents (Figure 3). These acid-activated pro-drugs get converted to sulphonamides or sulphonic acids and covalently react with cysteine residues that are present on the luminal surface of the pump (Shin and Kim 2013). They are administered in inactive form. These neutrally charged, lipophilic drugs cross thecell membranesand reach the acidic intracellular compartments. The inactive drug gets protonated and rearranged into active form. This active form covalentlybinds to the pump and deactivates it. Thus, it can be concluded that stomach ulcers belong to a category of peptic ulcer diseases. Excess gastric juice secretion, decreased mucosal defence and Helicobacter pylori infection are some of the common factors that contribute to the occurrence of the condition. The drugs that are used to treat the condition target mucosal defence and gastric acidity to reduce the symptoms. Of the many drugs used, proton pump inhibitors are thought to be most effective owing to their irreversible binding mechanism. References Alhazzani, W., Alenezi, F., Jaeschke, R.Z., Moayyedi, P. and Cook, D.J., 2013. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis.Critical care medicine,41(3), pp.693-705. Barazandeh, F., Yazdanbod, A., Pourfarzi, F., Sepanlou, S.G., Derakhshan, M.H. and Malekzadeh, R., 2012. Epidemiology of peptic ulcer disease: endoscopic results of a systematic investigation in iran.Middle East journal of digestive diseases,4(2), p.90. dhsgi.com (2017).Stomach Ulcers | Treatment | Tacoma | Digestive Health Specialists. [online] Digestive Health Specialists - Washington. Available at: https://www.dhsgi.com/disorders-symptoms/peptic-stomach-ulcers/ [Accessed 25 Oct. 2017]. Laine, L., Kivitz, A.J., Bello, A.E., Grahn, A.Y., Schiff, M.H. and Taha, A.S., 2012. Double-blind randomized trials of single-tablet ibuprofen/high-dose famotidine vs. ibuprofen alone for reduction of gastric and duodenal ulcers.The American journal of gastroenterology,107(3), pp.379-386. Salama, N.R., Hartung, M.L. and Mller, A., 2013. Life in the human stomach: persistence strategies of the bacterial pathogen Helicobacter pylori.Nature Reviews Microbiology,11(6), pp.385-399. Shin, J.M. and Kim, N., 2013. Pharmacokinetics and pharmacodynamics of the proton pump inhibitors.Journal of neurogastroenterology and motility,19(1), p.25.