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Peptic Ulcer Treatment
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Medicine notes on peptic ulcers
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PEPTIC ULCER TREATMENT(1) Describe the principles of peptic ulcer disease therapy
• Therapeutic principles
• Remove irritants e.g. NSAIDs
• Symptomatic relief
• Acid suppression
• Helicobacter pylori eradication; Test and treat. Prevention of relapse and complications
• Ulcer healing
• Must consider the increased risk of gastric carcinoma
Factors causing Ulceration
• Helicobacter Pylori infection
• NSAIDs
• Nicotine can cause an increase in acid secretion
(2) List the potential areas of the parietal cell peptic acid secretion control that can be
targeted by drugs in both predisposing and treating peptic ulcer disease
• Peptic Ulcers; defect in gastric/duodenal mucosa due to imbalance in the peptic acid
secretion and gastroduodenal mucosal defence
• The gastric mucosa is the mucous membrane layer of the stomach which contains
gastric glands
• The gastric glands contain parietal cells; secrete HCL
• Drugs target this area
(3) Compare proton pump inhibitors with histamine2-receptor antagonists in terms of
mode of action, efficacy and adverse effects
• Treatment
• Antacids; reduces pain associated with the ulcer (aluminium
and Mg salts used)
• Neutralises acid with alkali.
• Produce symptomatic relief by raising gastric pH and reducing proteolytic activity
• Milk shouldn’t be used
• Sodium bicarbonate can cause alkalosis
• Proton Pump Inhibitors (PPIs); 'PRAZOLE': ome, lanso, panto,
esome
• Caution; Other drugs that end in prazole aren't always PPIs
• Reduce the amount of acid in the stomach
• MOA; blocks the gastric proton pump (H/K/ATPase)
• 1st line agent in Peptic ulcer disease and reflux oesophagitis e.g. GORD
• Omeprazole; indicated in peptic ulcer disease and reflux oesophagitis e.g. GORD
• Very effective and relatively well tolerated in the short term
• They can mask gastric cancer
• Common Adverse effects; GI disturbance and headache
• Important Adverse Effects; Increased risk of clostridium difficile infection (chronic use
may change the microbiome), low Na and Mg levels (electrolyte balance issues; also
caused by diuretics)
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