Dyspepsia GERD Peptic Ulcer Gastritis• Abnormal function • Defect in • Inflammation (dysfunction) of the gastrin of lining of muscles of the production the stomach organs of the regulation -> • Caused by: gastrointestinal induction of Alchol tract acid Sever• May be functional production infection or organic from parietal NSAIDS (ulcerative) cells -> erosion of mucosa -> ulcer. • Caused by : H.Pylori NSAIDS
Dyspepsia GERD Peptic Ulcer Gastritis• heart burn • Heartburn • Abdominal • Burbing • Regurgitation pain• Early satiety • Dysphagia increased • Bloating • Odynophagia by food• Flatulence • Increased • Loss of • Unexplained salivation appetite weight loss• Fullness • Nausea • Heart burn • Chest pain • N&V • Yellow ,• N&V • Asthma false green or symptoms • May lead to bloody• Epigastirc pain perforation vomiting
Esomeprazole vs. Omeprazole esomeprazole is the s-enantiomar of omeprazole (racemic mixture) less first pass metabolism -> higher bioavailability -> more effective and longer lasting acid blockage -> 24 h interval Esomeprazole has increased antimicrobial activity against Helicobacter pylori than omeprazole. most of the esomeprazole metabolized by slower acting 3a4 enz, and the remaining metabolized by fast acting 2c19 , also it binds irreversibly to proton pump inhibiting acid secretion Journal of Clinical Gastroenterology: July 2004 - Volume 38 - Issue 6 - pp 503-506
Indication• Treatment GERD• Dyspepsia• H.Pylori (in combination with clarithromycin or amoxicillin)• Healing and maintenance of Erosive esophagitis• Peptic ulcer especially NSAIDS-associated• Pathological hyper secretory condition e.g. : Zollinger-Ellison
Side effects diarrhea, Nausea & vomiting headaches rash and dizziness Nervousness abnormal heartbeat muscle pain, weakness and leg cramps water retention :infrequently.
Drug – drug interaction: Increase blood concentration of: Diazepam : decrease its hepatic elimination Digoxin : increase its gastric absorption Decrease concentration of: Ketoconazole : decrease its gastric absorption
Dosage: For GERD: 20 or 40 mg of esomeprazole once daily for 4-8 weeks For H. pylori: 40 mg once daily + amoxicillin and clarithromycin for 10 days. The dose for preventing NSAID-induced ulcers : 20 to 40 mg daily for 6 months. Zollinger-Ellison syndrome: 40 mg twice daily.