Current Medical Management of Peptic Ulcer Disease


peptic ulcer

Summary Of peptic ulcer Disease:

 Gastric ulceration occurs due to increased gastric secretion or due to any microbial infection. The therapeutic management include the use of antibiotics and the drugs which reduces the gastric secretion .Minor ulcers are treated by drug therapy although long term treatment is required to avoid the chances of reoccurrences .Drug induced gastric ulcer is the main focusing problem however efficacious drugs are now used for this.

Pathophysiology of Peptic ulcer:

The peptic ulcer is a disease in the gastric lining mostly occurred from the combine effect of secreted acid and pepsin. Pepsin is a proteolytic enzyme which require acidic medium for its action. Increased pepsin and acid secretion is found in gastric and duodenal ulcer patients and appear to play an active role in ulcer formation.  Not all ulcers, however, are accompanied by excessive gastric secretion. Gastric ulcers may occur in normal or even low gastric secretion.
The cytoprotective action is responsible for the treatment of ulcers without any decrease in pepsin or acid secretion. This mechanism is not well known but it shows the regeneration of epithelial cells, mucosal bicarbonate secretion, mucosal prostaglandin and upper mucous coat. The gastric or duodenal ulcer is treated as quickly as the ulcer in any part of body.

TREATMENT OF PEPTIC ULCER:

Placebo Therapy

It is shown that about 80% of peptic ulcer is treated with placebo treatment with in one month.2 they are generally lower than that. However there is a chance of healthiness even with a placebo therapy .The placebo therapy become responsible for the popularity of ineffective therapy.

Clinical trials with routine endoscopic follow up also found another unexpected fact: many active ulcers are asymptomatic this may not be wonderful because many ulcerative patients did not have any signs earlier. endoscopic evaluation described that gastric ulcer repetition will be asymptomatic in the clients who have symptoms earlier.5'6 this shows that finding signs of peptic ulcer is very difficult.

Antacid Therapy

A strongly acidic environment is required for the proteolytic action of pepsin enzyme. Even very small amount of alkalinity in medium finishes its activity and also the degenerative activity of the acids. Therefore antacid therapy is very beneficial .In control study it found that antacid therapy treat the ulcer as beneficial as the other therapies.7Then why people not taken it mostly.

it is because of its uneasiness in use as the other treatments. Clients must take one and three doses after each meal and also before sleep. Some clients does not like it while some patients stop its administration before healing the ulcer just on relieving of symptoms. Magnesium presence may causes diarrhea while calcium carbonate may stimulate gastric secretion after therapy. That is why its use has been stopped.

H2-Antagonists

Cimetidine (Tagamet et al.) is a competitive antagonist of histamine, which blocks its attachment to
H2-receptors and inhibits acid secretion.8 its treating activity is faster than the placebo therapy. Cimetidine is the most famous drug in gastric ulcer as well as in peptic syndrome not related to peptic ulcer. Many patients took the drug for short courses on demand. Its use in non-ulcer dyspepsia is debatable and beyond the scope of this paper. Although 300 mg q.i.d. was initially administered for minor therapy, 600 mg b.i.d. was soon known to be as efficacious and best accepted by patients. Cimetidine treatment is related to many uncommon but effective side effects.

Drowsiness and reversible confusion may occur specifically in older ones. Cimetidine co-administration can prolong metabolism and excretion of some drugs and significantly raise their blood levels in the body. Co-administration of cimetidine with warfarin should be closely monitored because of inhibition of warfarin metabolism. Without these cimetidine is most acceptable by the patients and because of cost effectiveness it has most potential for market led to the development of other H2 antagonists. Ranitidine was released second after the cimetidine

Coating Agents

Sucralfate released most quickly after the cimetidine for the ulcer therapy. It bind to the ulcerative area and form a jelly like substances which protect the acid, pepsin, and bile acid to bind with diseased area. Sucralfate actions superficially and shows some side effects without for constipation in some patients. Drug should be given one hour before meal and at sleep time also.

Concomitant use may interfere with absorption of some drugs and is not available in generic form. Concomitant use of sucralfate with NSAIDS is useful in the treatment of ulcer .However not the sucralfate nor the H2-antagonist is effective in the treatment of ulcer disease.10

Prostaglandins

Misoprostol (Cytotec), a prostaglandin E1 analogue, combines anti secretory and cytoprotective actions. Diarrhea is the first amendable in many clients, but if we keep maintain our therapy then improve the health. However it is very difficult for the constipative patients. Misoprostol should be prohibited in pregnancy because it do abortion.

It is currently approved for treatment of duodenal ulcer at a dose of 200ug q.i.d after meals and at bedtime misoprostol reduces the chances of ulcer with NSAIDS use .That is why the drug is given in steps of 400 to 800microgm/day and also for NSAIDS INDUCED ulcer. NSAIDS induced ulcerative patients are treated with prostaglandins.

Miscellaneous Agents

Pirenzepine (Gastrozepin) is because of its anti-secretory activity is given for the ulcer disease. However it is not as much as effective as that of H2 receptor blocker.

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Haseenullah Shah

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