Filetype PDF | Posted on 06 Jan 2023 | 2 years ago
Authentication
digital resources
175x Filetype PDF File size 0.29 MB Source: sphinxsai.com
International Journal of PharmTech Research
CODEN (USA): IJPRIF ISSN : 0974-4304
Vol.2, No.1, pp 970-980, Jan-Mar 2010
RECENT TRENDS OF TREATMENT AND MEDICATION
PEPTIC ULCERATIVE DISORDER
1 1 1 1 2
Debjit Bhowmik *, Chiranjib , K.K.Tripathi , Pankaj , K.P.Sampath Kumar
1
Rajeev Gandhi college of Pharmacy, Nautanwa,Maharajganj,Uttar Pradesh,India.
2
Department of Pharmaceutical sciences, Coimbatore medical college,Coimbatore,India.
*Email-debjit_cr@yahoo.com
ABSTRACT: Most peptic ulcers can be healed with proper treatment. Research has found that the majority of peptic
ulcers are caused by an infection with a bacterium called Helicobacter pylori (H. pylori), and standard treatment in these
cases is a combination of drugs, including antibiotics and a proton pump inhibitorPeptic ulcers are open sores or erosions
in the lining of either the duodenum (duodenal ulcers) or the stomach (gastric ulcers). The duodenum is the first part of
the small intestine. Contrary to popular belief, ulcers are not caused by spicy food or stress but instead are most
commonly due to either an infection or long-term use of certain medications. The main goals for treating a peptic ulcer
include eliminating the underlying cause (particularly H. pylori infection or use of NSAIDs), preventing further damage
and complications, and reducing the risk of recurrence. The discovery of the link between ulcers and H. pylori has
resulted in a new treatment option. Now, in addition to treatment aimed at decreasing the production of stomach acid,
doctors may prescribe antibiotics for patients with H. pylori. By eliminating H. pylori means the ulcer may now heal and
most likely will not come back. However, antibiotics alone are not used to treat H Pylori. The most commonly
recommended first-line treatment is a combination of a proton pump inhibitor and the antibiotics amoxicillin and
clarithromycin for two weeks. In penicillin allergic people, a drug called metronidazole is sometimes substituted for the
amoxicillin. Medication is almost always needed to alleviate symptoms and must be used to eradicate H. pylori. Surgery
is required for certain serious or life-threatening complications of peptic ulcers and may be considered if medications are
not working.
Key words: Peptic Ulcerative Disorder.
INTRODUCTION family history and blood group O. deally patients
Peptic ulcer is a lesion in the mucosa of the stomach or should stop taking NSAIDs, but often this may not be
duodenum in which acid and pepsin play a major role, possible; alternatives include the concomitant long-
the term is often used to encompass any gastric or term use of a proton pump inhibitor. General advice
duodenal ulceration. This includes ulceration that may involves stopping smoking and reducing alcohol
occur from drugs (NSAIDs) or excessive gastrin intake, but there is little evidence to support the
production (Zollinger-Ellison syndrome).Peptic ulcer efficacy of these recommendations.First-line triple
disease is common. It usually presents after the age of therapy for H. pylori eradication consists of a proton
15 and is equally common in both sexes. The currently pump inhibitor with either clarithromycin and
most widely accepted causative agent is H. pylori. amoxicillin or clarithromycin and metronidazole.
Approximately 95% of duodenal ulcers and 70% of Although many combinations and treatment durations
gastric ulcers are associated with H. pylori (but only have been proposed, the most effective are the twice-
15% of H. pylori colonized individuals will develop daily dosing, 1-week duration regimens such as
peptic ulcer disease). The odds of developing peptic omeprazole 20 mg twice daily, amoxicillin 1 g twice
ulceration are increased 2-fold in H. pylori positive daily and clarithromycin 500 mg twice daily. Initial
patients. Peptic ulceration is also more common in eradication regimens progressively change due to
patients on NSAIDs (Non Steroidal Anti Inflammatory failure rates associated with the development of
Drugs) (36%) as compared to patients who are not on antibiotic-resistant strains of H. pylori. Currently
NSAIDs (8%) in clinical studies. Weaker associations metronidazole-resistant strains are common and
of peptic ulcer disease include smoking, alcohol, clarithromycin resistance is increasing. Dual therapy
Debjit Bhowmik et al /Int.J. PharmTech Res.2010,2(1) 971
often fails to eradicate H. pylori and promotes Antacids such as Maalox, Mylanta, and Amphojel are
emergence of resistant organisms. Rescue therapy for safe and effective treatments. However, the
failed initial eradication should consist of a different neutralizing action of these agents is short-lived, and
combination of antibiotics to that used for initial frequent dosages are required. Magnesium containing
treatment, administered for 10-14 days. Selection of antacids, such as Maalox and Mylanta, can cause
further antibiotic treatment should be based on diarrhea, while aluminum agents like Amphojel can
antimicrobial susceptibilities from primary or cause constipation. Ulcers frequently return when
secondary endoscopy biopsy culture results.A proton antacids are discontinued. Studies have shown that a
pump inhibitor is currently the standard treatment, and protein in the stomach called histamine stimulates
part of triple therapy. Thereafter, symptomatic gastric acid secretion. Histamine antagonists (H2
patients, those with complicated peptic ulcer disease blockers) are drugs designed to block the action of
(presenting with bleeding, stricture or perforation) and histamine on gastric cells, hence reducing acid output.
those patients who require NSAIDs may still require Examples of H2 blockers are cimetidine (Tagamet),
long-term proton pump inhibitor therapy. Intermittent ranitidine (Zantac), nizatidine (Axid), and famotidine
on-demand therapy is suitable for patients without (Pepcid). While H2 blockers are effective in ulcer
complications for the control of symptoms.Peptic ulcer healing, they have limited role in eradicating H. pylori
surgery is now extremely rare for failed medical without antibiotics. Therefore, ulcers frequently return
therapy due to the powerful acid suppression by proton when H2 blockers are stopped. Generally, these drugs
pump inhibitors. Currently surgery is usually reserved are well tolerated and have few side effects even with
for the development of complications such as long term use. In rare instances, patients report
perforation, severe bleeding and rarely stricture headache, confusion, lethargy, or hallucinations.
formation. In patients with gastric or duodenal Chronic use of cimetidine may rarely cause impotence
perforation, a primary repair is usually performed on or breast swelling. Both cimetidine and ranitidine can
laparotomy. A pyloroplasty to increase the diameter of interfere with body's ability to handle alcohol. Patients
the gastric outlet may be performed for patients with on these drugs who drink alcohol may have elevated
pyloric stenosis due to peptic stricture. A longitudinal blood alcohol levels. These drugs may also interfere
incision is performed through the pylorus and closed with the liver's handling of other medications like
as a transverse defect. Alternatively, a Dilantin, Coumadin, and theophylline. Frequent
gastroenterostomy may be performed to bypass the monitoring and adjustments of the dosages of these
narrowed pylorus. Gastrectomy is rarely performed medications may be needed. Proton-pump inhibitors
unless there is evidence of malignancy. Peptic ulcer such as omeprazole (Prilosec), lansoprazole
disease is a chronic relapsing condition. Symptom (Prevacid), pantoprazole (Protonix), esomeprazole
control with proton pump inhibitor therapy is usually (Nexium), and rabeprazole (Aciphex) are more potent
achieved in the vast majority. Up to 15% may suffer than H2 blockers in suppressing acid secretion.
with upper gastrointestinal haemorrhage requiring Different proton-pump inhibitors are very similar in
hospital admission, and less than 5% will require action and there is no evidence that one is more
surgical interventionPeptic ulcer disease refers to an effective than another in healing ulcers. While proton-
erosion in the inner lining of the stomach or the first pump inhibitors are comparable to H2 blockers in
part of the small intestine called the duodenum. effectiveness in treating gastric and duodenal ulcers, it
Specifically, these erosions penetrate as deep as the is superior to H2 blockers in treating esophageal
muscular layer of the gastrointestinal tract. The ulcers. Esophageal ulcers are more sensitive than
condition affects men and women equally with a gastric and duodenal ulcers to minute amounts of acid.
lifetime prevalence of 10%.Treatment of peptic ulcer Therefore, more complete acid suppression
disease requires removal of the cause. Smoking and accomplished by proton-pump inhibitors are important
NSAIDs should be stopped if they are identified as for esophageal ulcer healing. Proton-pump inhibitors
likely causative factors. If H. pylori is involved, are well tolerated. Side effects are uncommon; they
treatment involves a proton-pump inhibitor include headache, diarrhea, constipation, nausea and
medication, such as omeprazole (Prilosec), and two rash. Interestingly, proton-pump inhibitors do not have
antibiotics, which may include clarithromycin, any effect on a person's ability to digest and absorb
amoxicillin, or metronidazole. Surgery, less commonly nutrients. Proton-pump inhibitors have also been found
performed as a result of improved medication to be safe when used long term, without serious
regimens for H. pylori, is generally reserved for cases adverse health effects reported. Sucralfate (Carafate)
of perforated ulcers. The goal of ulcer treatment is to and misoprostol (Cytotec) are agents that strengthen
relieve pain and to prevent ulcer complications, such the gut lining against attacks by acid digestive juices.
as bleeding, obstruction, and perforation. The first step Carafate coats the ulcer surface and promotes healing.
in treatment involves the reduction of risk factors The medication has very few side effects. The most
(NSAIDs and cigarettes). The next step is medications. common side effect is constipation and the interference
Antacids neutralize existing acid in the stomach. with the absorption of other medications. Cytotec is a
Debjit Bhowmik et al /Int.J. PharmTech Res.2010,2(1) 972
prostaglandin-like substance commonly used to and pepsin, an enzyme that helps breakdown protein)
counteract the ulcer effects of NSAIDs. Studies stop working or the acid production is too
suggest that Cytotec may protect the stomach from overwhelming for these protective defenses to work
ulceration in those who take NSAIDs on a chronic properly, you can get an ulcer. There are a few
basis. Diarrhea is a common side effect. Cytotec can different ways this happens.
cause miscarriages when given to pregnant women, v Helicobacter pylori (H. pylori) -- H. Pylori, a
and should be avoided by women of childbearing age. bacterial organism, is responsible for most ulcers.
Many people harbor H. pylori in their stomachs This organism weakens the protective coating of
without ever having pain or ulcers. It is not completely the stomach and duodenum and allows the
clear whether these patients should be treated with damaging digestive juices to irritate the sensitive
antibiotics. More studies are needed to answer this lining below. Interestingly, as many as 20% of
question. Patients with documented ulcer disease and Americans over age 40 have this organism living
H. pylori infection should be treated with antibiotic in their digestive tract, but not all of these people
combinations. H. pylori can be very difficult to develop ulcers -- most do not.
completely eradicate. Treatment requires a v Non-steroidal anti-inflammatory drugs (NSAIDs) -
combination of several antibiotics, sometimes in - ongoing use of this class of medications is the
combination with a proton-pump inhibitor, H2 second most common cause of ulcers. These drugs
blockers or Pepto-Bismol. Commonly used antibiotics (which include aspirin, ibuprofen, naproxen,
are tetracycline, amoxicillin, metronidazole (Flagyl), diclofenac, tolmetin, piroxicam, fenoprofen,
clarithromycin (Biaxin), and levofloxacin (Levaquin). indomethacin, oxaprozin, ketoprofen, sulindac,
Eradication of H. pylori prevents the return of ulcers (a nabumetone, etodolac, and salsalate) are acidic.
major problem with all other ulcer treatment options). They block prostaglandins, substances in the
Elimination of this bacteria may also decrease the risk stomach that help maintain blood flow and protect
of developing gastric cancer in the future. Treatment the area from injury. Some of the specific drugs
with antibiotics carries the risk of allergic reactions, listed are more likely to produce ulcers than
diarrhea, and sometimes severe antibiotic-induced others. Therefore, if you must use long-term pain
colitis (inflammation of the colon). There is no medications, talk to your doctor about which ones
conclusive evidence that dietary restrictions and bland are safest.
diets play a role in ulcer healing. No proven v Zollinger-Ellison syndrome -- people with this
relationship exists between peptic ulcer disease and the uncommon condition have tumors in the pancreas
intake of coffee and alcohol. However, since coffee and duodenum that produce gastrin, a hormone
stimulates gastric acid secretion, and alcohol can cause that stimulates gastric acid production. Diarrhea
gastritis, moderation in alcohol and coffee may precede ulcer formation.
consumption is often recommended. v Other causes of ulcers are conditions that can
result in direct damage to the wall of the stomach
CAUSES OF PEPTIC ULCER8,11 or duodenum, such as heavy use of alcohol,
When the stomach's natural protections from the radiation therapy, burns, and physical injury.
damaging effects of digestive juices (including acid
FIGURE-PEPTIC ULCER DISEASE
Debjit Bhowmik et al /Int.J. PharmTech Res.2010,2(1) 973
5,6,7 v Patients on steroids may develop acute ulcers,
SYMPTOMS
Peptic ulcers are open sores that develop on the inside known as ’steroid ulcers’.
lining of your stomach, upper small intestine or CHRONIC PEPTIC ULCERS ARE DIVIDED
esophagus. The most common symptom of a peptic INTO GASTRIC ULCER AND DUODENAL
ulcer is abdominal pain. It wasn't too long ago that ULCER5,20.21
lifestyle factors, such as a love of spicy foods or a Gastric ulcer
stressful job, were thought to be at the root of most v Diminished mucosal resistance - due to lowering
peptic ulcers. Doctors now know that a bacterial of the ability to resist the effect of acid pepsin
infection or some medications — not stress or diet — digestion causes gastric ulcer.
cause most peptic ulcers. Burning pain is the most v Pyloro-duodenal reflux - Regurgitated bile and
common peptic ulcer symptom. The pain is caused by other duodenal juices have been taken to be the
the ulcer and is aggravated by stomach acid coming in prime cause of pre-ulcerative superficial gastritis.
contact with the ulcerated area. The pain typically Such biliary reflux may account for a large number
may: of gastric ulcer cases.
1) Be felt anywhere from your navel up to your v Deficient mucous barrier - A surface layer of
breastbone mucus protects normally from the digestive effect
2) Last from a few minutes to several hours of the hydrochloric acid and pepsin. When this
3) Be worse when your stomach is empty mucous barrier becomes deficient gastric ulcer
4) Flare at night may develop. Most cases of gastric ulcers produce
5) Often be temporarily relieved by eating certain large quantities of mucus.
foods that buffer stomach acid or by taking an v Mucosal trauma - 85% of gastric ulcers occur
acid-reducing medication along the lesser curve of the stomach. This part of
6) Disappear and then return for a few days or weeks the stomach is exposed to injurious effects of heat
7) Less often, ulcers may cause severe signs or and trauma.
symptoms such as: v Local ischemia - arterio-venous shunts which are
8) The vomiting of blood — which may appear red or present in the sub-mucosa of the stomach are
black under control of sympathetic nervous system and
9) Dark blood in stools or stools that are black or excessive stress and strain may cause diminution
tarry of blood supply to the mucous membrane of the
10) Nausea or vomiting stomach leading to ulcer formation.
11) Unexplained weight loss v antral stasis - As the gastric ulcer patients have
12) Appetite changes low acid content some factor such as injury to the
gastric mucosa which renders it more susceptible
PEPTIC ULCERS ARE DIVIDED INTO ACUTE to acid peptic damage may lead to ulcer formation.
AND CHRONIC ULCERS - v Non-steroidal anti-inflammatory drugs (NSAIDs) -
Acute peptic ulcers ingestion of these drugs in patient suffering from
Etiology arthritis as a long term basis are a significant
v Half of the patients give history of etiologic factor at present time. The drugs of this
ingestion of aspirin or anti-inflammatory drugs. group are often called as ulcerogenic drugs.
v Helicobacter pylori - it is a spirochetal bacterium
v Sometimes these acute ulcers may occur following which exits in the deep mucosal layer of the
stress, when they are called ’stress ulcers’. This antrum mainly and duodenum rarely is associated
may occur following hypotension from with ulcer disease.
hemorrhage, endotoxin shock or cardiac infarction.
v Sepsis is an important etiological factor. Un- Duodenal ulcers
drained pus may be responsible for acute stress v Acid hyper-secretion - Duodenal ulcer is
ulcers. Upper gastrointestinal bleeding from these seemingly simplified at first sight by a clear
ulcers may be seen in critically ill patient and relationship to over-production of hydrochloric
should be a signal of search for pus. acid by the stomach.
v These acute ulcers are seen after cerebral trauma v Genetic factors - in a great number of cases the
or neurological operations. acid production may be within the high side of the
v After major burns acute ulcers may be seen normal range and in these cases ulceration cannot
(Curling’s ulcer). Within first 48hrs multiple be explained except the diminished mucosal
erosions may develop anywhere in the body and resistance to normal acid secretion. Diminished
fundus of the stomach. During convalescent period power of resistance of the mucosa has also been
of such burn cases, acute duodenal ulcer may incriminated to cause duodenal ulcer. There is a
occur which often become chronic. significant relationship between blood group ‘O’
and the development of duodenal ulcer.
no reviews yet
Please Login to review.
