What is Peptic Ulcer?
Peptic ulcer or stomach ulcer is the condition that occurs as a result of imbalance between aggressive factors and defensive factors.
Aggressive factors: Gastric acid, gastrin, pepsin
Defensive factors: Prostaglandin, mucosa, bicarbonate
Peptic ulcers or stomach ulcers have been known since ancient times and treatment has been given as per their knowledge.
A lot of research was carried out from 19th century onwards and they had found that acid neutralization was the effective treatment for ulcers.
Cause of Peptic Ulcer
It was found out that bacteria named as Helicobacter pylori (H. pylori) is known to be the cause of peptic/stomach ulcer and its recurrence.
So the main aim of anti-ulcer drug is to decrease the level of gastric acidity or to enhance mucosal secretion as the basic level of protection.
New approaches were carried out for prevention of ulcers and to remove the microorganism,if an ulcer is caused by an infectious agent.
Gastric Acid secretion Physiology
The gastric acid secretion is a complex and continuous process in which many central and peripheral factors contribute to the H+ secretion by the parietal cells.
Acetylcholine (M3), histamine (H2) and gastrin (CCK2) are the factors that regulate gastric acid secretion corresponding to neuronal, paracrine and endocrine systems.
Specific receptors namely M3, H2 and CCK2 receptors are present on basolateral membrane of parietal cells in the body and fundus region of the stomach.
Symptoms of Peptic Ulcer Disease
Abdominal epigastric pain may be felt severely after three hours of taking meals. PUD also causes loss of appetite and weight loss. Waterbrash that cause secretion of saliva after regurgitation may occur to dilute the acid in the esophagus. Nausea and vomiting may also occur.
Peptic Ulcer Disease complications
Gastrointestinal bleeding: GI bleeding is the common complication but sudden large bleeding may be come life threatening. Bleeding occurs when the blood vessels are eroded by ulcers.
Perforation may lead to catastrophic consequences. If ulcer causes erosion of the gastrointestinal wall, it leads to the spillage of contents of stomach or intestine into the abdominal cavity.
Peritonitis: If perforation occurs at the anterior surface of the stomach, it may cause acute peritonitis, initially chemical and finally to bacterial peritonitis. The main sign is the sudden occurrence of intense abdominal pain.
Pancreatitis: If perforation is caused at the posterior surface, it leads to pancreatitis. In this inflammation, the pain often radiates to the back.
Penetration is caused when the ulcer continuous into other adjacent organs like liver and pancreas. If ulcers lead to scarring and swelling, it causes narrowing in the duodenum and obstruction in the gastric outlet. In such condition, patients feel severe vomiting.
What are Anti-Ulcer Drugs?
Anti-ulcer drugs are the drugs used for treating the peptic ulcers and intestinal ulcers:
Pharmocological classification of the anti-ulcer drugs:
- Reduction of gastric acid secretion:
- H2 antihistaminics – Cimetidine, Ranitidine, Famotidine, Roxatidine, Loxatidine etc
- Proton Pump Inhibitors – Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole, esomeprazole etc
- Anti-cholinergics – Pirenzepine, Propantheline, Oxyphenonium etc
- Prostaglandin analogues – Misoprostil, Enprostil, Rioprostil etc
2. Neutralisation of gastric acid:
Antacids are used for neutralising the gastric acid in the stomach. These drugs are known as antacids.
- Systemic antacids – sodiumbicarbonate (NaHCO3), sodium citrate etc
- Non systemic antacids – Magnesium hydroxide (Mg(OH)2), Magnesium trisilicate, Alminium hydroxide gel, Calcium carbonate (CaCO3) etc
3. Ulcer protectives:
Ulcer protectives protect the ulcers by covering them and they consist of mainly polymers.
- Sucralfate, Colloidal Bismuth subcitrate (CBS) etc
4. Ulcer Healing Drugs:
- Carbenoxolone sodium
5. Anti H-Pylori drugs:
Ulcer is also caused due to the action of the bacterium Helicobacter Pylori, so for treating the ulcers caused by the bacterium, anti biotics are given.
Adverse Effects of Anti-Ulcer Drugs
Anti-ulcer drugs may cause headache, dizziness and bowel upset.
Cimetidine may cause gynecomastia and galactorrhea. These are contraindicated for persons with renal impairment and hepatic failure.
Large doses of Antacids may produce alkalosis.
Anti ulcer drugs should be generally taken before breakfast. Antacids should be taken one hour after eating food.