Peptic ulcer and gerd

treatment and other aspects of peptic ulcers and GERD

1. Peptic Ulcer And GERD Krupanidhi College of Pharmacy, Bangalore Presented By- Bhavya Rewari M.Pharm . Ist Year Dept. of Pharmacology 1

2. Peptic Ulcer Disease 2

3. Definition and Introduction Peptic ulcer is a chronic lesion that occurs in any portion of the GIT (usually stomach) exposed to the aggressive action of acid-peptic juices At least 98 % of peptic ulcers are in the upper portion of the duodenum Peptic ulcer disease mainly comprises of painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer 3

4. Definition and Introduction It causes disruption of the mucosal integrity of the stomach, duodenum, or both caused by local inflammation, which leads to a well-defined mucosal defect Peptic ulcers are relapsing lesions that most often diagnosed in middle-aged to older adults Duodenal ulcers are more frequent in patients with alcoholic cirrhosis, COPD and chronic renal failure Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in the stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation ( gastritis ) or an ulcer. 4

5. Pathogenesis 5 The imbalance between defensive mechanism and aggressive factors (gastric acid and pepsin and H. pylori) Defensive mechanism include; Secretion of mucus by epithelial cells Secretion of bicarbonate which act as buffer Rapid gastric epithelial regeneration Mucosal blood flow to sweep away hydrogen ion

6. Pathogenesis 6 Aggressive factors ; Secretion of gastric HCl from the parietal cells Secretion of pepsin Presence of H.pylori which survives in the gastric mucosal layer Agents that increase the complications- NSAIDs drug therapy Cigarette smoking Alcohol Corticosteroids therapy

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9. Signs and symptoms 9 Epigastric pain The pain tends to be worse at night and occurs 1 to 3 hrs after meals Nausea Vomiting Belching Significant weight loss Complications of hemorrhage occurs in one-third patients Feeling of fullness - unable to drink as much fluid Pain or discomfort in the upper abdomen Bloody or dark tarry stools

10. Some common causes 10 Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs Smoking cigarettes or chewing tobacco Being very ill, such as being on a breathing machine Having radiation treatments A rare condition called  Zollinger -Ellison syndrome  causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid.

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12. Treatment 12 Treatment involves a combination of medications to kill the  H. pylori  bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance of a relapse If one has a peptic ulcer with an  H. pylori  infection, the standard treatment uses different combinations of the following medications for 5 - 14 days: Two different antibiotics to kill  H. pylori , such as clarithromycin ( Biaxin ), amoxicillin, tetracycline, or metronidazole ( Flagyl ) Proton pump inhibitors such as omeprazole ( Prilosec ), lansoprazole ( Prevacid ), or esomeprazole ( Nexium ) Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

13. Treatment 13 If one has an ulcer without an  H. pylori  infection, or one that is caused by taking aspirin or NSAIDs, the doctor will likely prescribe a proton pump inhibitor for 8 weeks Other medications that may be used for ulcer symptoms or disease are: Misoprostol , a drug that may help prevent ulcers in people who take NSAIDs on a regular basis Medications that protect the tissue lining (such as sucralfate )

14. Anti ulcer drugs- Classification 14 Gastric Acid Secretion Inhibitors H2 Antihistaminics - Ranitidine, Famotidine Proton Pump Inhibitors- Omeprazole , Lansoprazole , Pantoprazole Anticholinergics - Pirenzepine Prostaglandin Analogues- Misoprostal Gastric neutralizers (Antacids) Systemic- Sodium Bicarbonate Non- Systemic-Mag. Hydroxide, Al. Hydroxide

15. Anti ulcer drugs- Classification 15 Ulcer Protectives - Sucralfate , Colloidal Bismuth Subcitrate Anti H. Pylori drugs- Amoxicillin, Metronidazole , Tetracycline

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17. Gastro esophageal reflux disease (GERD) 17

18. Definition and Introduction 18 It is chronic disease occurs due to mucosal damage caused by reflux stomach acid coming up from the stomach into the esophagus Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach Doctors believe that some people suffer from GERD due to a condition called   hiatal hernia

19. Pathophysiology 19 GERD is caused by a failure of the cardia (part of the stomach attached to esophagus) In healthy patients, the " Angle of His "—the angle at which the esophagus enters the stomach — creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue

20. Signs And Symptoms 20 Heartburn Regurgitation (expulsion of food particles from mouth) Trouble swallowing ( dysphagia ) Pain with swallowing ( odynophagia ) Excessive salivation Nausea Chest pain Dyspepsia Barret’s Esophagus

21. Most Probable Causes 21 GERD is caused by a failure of the lower esophageal sphincter. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue GERD has been linked to a variety of respiratory and laryngeal complaints such as laryngitis, chronic cough, pulmonary fibrosis, earache and asthma, even when not clinically apparent. These atypical manifestations of GERD is commonly referred to as laryngopharyngeal reflux or as extraesophageal reflux disease (EERD)

22. Most Probable Causes 22 Factors that can contribute to GERD: Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index Zollinger -Ellison syndrome, which can be present with increased gastric acidity due to gastrin production

23. Most Probable Causes 23 Hypercalcemia, which can increase gastrin production, leading to increased acidity Scleroderma and systemic sclerosis, which can feature esophageal dysmotility Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach The use of medicines such as prednisolone

24. Prevention 24 Relief is often found by; Raising the head off the bed Raising the upper body with pillows Sleeping sitting up Eating a big meal causes excess stomach acid production, and attacks can be minimized by eating small frequent meals instead of large meals, especially for dinner. To minimize attacks, a sufferer may benefit from avoiding foods that may trigger their symptoms such as restricting the acidic fruit or juice, fatty foods, coffee, tea, chocolate, or highly spiced foods, especially shortly before bedtime

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26. Treatment 26

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28. Drug therapy- 28 Inhibitors or Neutralizers of gastric acid secretion Proton Pump Inhibitors- Omeprazole , Pantoprazole H2 Blockers- Ranitidine, Famotidine Antacids- Mg. Hydroxide, Al. Hydroxide Barrier Agent- Sodium Alginate Prokinetic Drugs (Enhance LES tone and promote Gastric Emptying )- Cisapride , Mosapride

29. References 29 http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease https://www.clinicalkey.com/topics/gastroenterology/peptic-ulcer-disease.html http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1  K D Tripathi , Pharmacological Classification of Drugs, 4 th edition.