this powerpoint slide cover peptic and duodenal ulcer and its treatments

1. Treatment Of Peptic
&
Duodenal Ulcer
Presented by:
Group 4, Pharm-D (batch IV)

2. What is an Ulcer?
Ulcers are sores that are slow to heal or keep returning. They can take
many forms and can appear both on the inside and the outside of your
body.
A fracture in the skin or mucous membrane that results in the loss of
surface tissue, epithelial tissue breakdown.
It can be of different types like:
• Leg and foot ulcer
• Stomach ulcer
• Mouth ulcer
“Muhammad Umar”

3. Peptic
&
Duodenal Ulcer

4. Peptic Ulcer:
A peptic ulcer is an open sore in the upper digestive tract.
There are two types of peptic ulcers:
1
A gastric ulcer, which forms in
the lining of the stomach.
2
A duodenal ulcer, which forms in the
upper part of the small intestine.

5. Cardia
Foveolar Cells secrete Mucus
Fundus and Body
Parietal Cells HCL
Chief Cells Pepsinogen
Pyloric Antrum
G-cells secrete Gastrin
HCL secretion is
controlled by
“Enterochromaffin
like cells” which
are influenced by
“Vagus Nerve”

6. Enteric nervous system
have reflex circuits that
need no instructions
from brain in order to
work
These reflex circuits are
“Myentric plexus” and
“submucosal plexus”
Enteric nervous system gives
acetylecholine
neurotransmitter, stomach
has many actylecholine
receptors which ultimately
increase HCL & Gastrin.

7. What is the reason behind Peptic and Duodenal ulcer?
• To break down food into tiny enough quantities
for efficient absorption, the stomach secretes
HCl.
• However, the stomach can create too much acid,
which erodes the mucosal layer and can lead to
a peptic ulcer (perforation of the mucosa).
• Acid from the stomach can spill into the
duodenum and erode the mucosa there as well,
arising duodenal ulcer.

8. Symptoms of Peptic Ulcer

9. Cigarette smokers, and diabetics are at a higher risk of developing
ulcers.
Those infected with Helicobacter pylori (H. pylori), and those who are
unable to cope with stress.
Alcohol, caffeinated meals and beverages, and certain medications
(corticosteroids, aspirin, and nonsteroidal anti-inflammatory
medicines (NSAIDs) can all contribute to the development of a peptic
ulcer.
H. pylori is linked to 75% of stomach ulcers and 90% of duodenal
ulcers.

10. Treatments
Of
Peptic Ulcer

11. • In the past, patients with peptic ulcers were encouraged to drink lots of milk because it
was thought that ulcers were related to the acidity of the stomach, and milk is alkaline.
• Now it is known that H. pylori grows very well in milk, and milk was perhaps one of the
worst treatments to recommend. This is why it is critical for health-care practitioners to
be up to date on research-based therapies.
• The following are some of the drugs used to treat peptic ulcers:
Antibiotics Mucosal protectants
Antacids Prostaglandins
Antispasmodics H2-receptor antagonists
Proton pump inhibitors.
“Sarah Bibi”

12. 1. Antacids:
• The quantity of hydrochloric acid (HCl) in the stomach is reduced by antacids.
• Antacids create a more alkaline environment, which neutralizes the acid and
protects the vulnerable mucosa, antacids are not readily absorbed and do not
alter the pH of the entire body.
• Some antacids may need to be used on a regular basis to train the stomach to
produce less acid.
• Timing of these medications is critical; they must be taken before food.
Sometimes antacids are given in suspension form or chewable tablets.

13. Some antacids are:
Magnesium hydroxide (Dulcolax, Phillips Milk of Magnesia)
magnesium oxide (Mag-ox 400, Uro-Mag)
aluminum hydroxide gel (Alterna gel)
calcium carbonate (Tums)

17. 2. Antibiotics:
• Antibiotics fight H. pylori.
• The ulcer has a chance to heal after the H. pylori is eradicated.
• Antibiotic agents are never used alone but in a combination of two antibiotics.
This method helps to prevent treatment failure as well as antibiotic resistance.
• Even though patients feel better, it is critical that they finish the whole 7 to 14
day programme in order to entirely eliminate the bacteria.
• Bismuth compounds can also be prescribed because they are bacteriostatic and
stop H. pylori from sticking to the mucosa.
“Syed Noman Shah”

18. Tetracycline
Clarithromycin (Biaxin)
Amoxicillin (Amoxil, Trimox)
Metronidazole (Flagyl)
Some antibiotics are:

19. 3. Mucosal Protectants:
• Mucosal protectants work to cover and protect the ulcer to
stimulate healing.
• These oral drugs must be taken first thing in the morning on an
empty stomach.
• Mucosal protectants such as Sucralfate (Carafate), which is
aluminum hydroxide and sulfated sucrose, are like a bandage
shielding a wound from dirt and injury and allowing it to heal.
“Muhammad Rizwan”

20. 4. Prostaglandins:
• The prostaglandins are a group of lipids made at sites of tissue damage or
infection that are involved in dealing with injury and illness. They control
processes such as inflammation, blood flow, the formation of blood clots
and the induction of labour
• Prostaglandins are important in the pathophysiology of peptic ulcer
disease and possibly in its prevention and treatment as well.
Prostaglandins have been shown to inhibit gastric secretion, stimulate
bicarbonate secretion, and increase gastric blood volume.
“Syeda Faiza Pirzada”

21. Mechanism Of Action
• Prostaglandins get produced in the body via the fatty acid arachidonic acid.
• Initially, arachidonic acid is created when the enzyme phospholipase A2 cleaves
the lipid diacylglycerol into the molecule arachidonic acid.
• Cyclooxygenase enzymes then produce prostaglandins from arachidonic acid via
sequential oxidation of each compound.
• The COX-1 enzyme produces basal amounts of prostaglandins, while chemical
mediators induce the COX-2 isoform to increase prostaglandins production.
Prostaglandins are highly lipophilic molecules that enter cells via a special
prostaglandin transporter called PGT (prostaglandin transporter). There, they
bind to prostaglandin receptors to exert their effects.

22. • There are currently nine known prostaglandin receptors in the body on which
prostaglandins exert their effects.
• All prostaglandin receptors are members of the G-protein coupled receptor signaling
family.
• As members of the G-protein signaling family, prostaglandins can activate secondary
signaling pathways by activating or inhibiting enzymes such as adenyl cyclase and
phospholipase C, causing downstream effects.
• In the stomach, prostaglandins can act on gastric parietal cells to inhibit acid secretion,
as well.
• Prostaglandins can cause vasodilation or vasoconstriction in vascular smooth muscle
cells, activate or inhibit platelet aggregation, induce labor, regulate hormones, and
decrease intraocular pressure. They can also act in the central nervous system to cause
fever and influence pain perception.

23. Some ulcer treating prostaglandins are:
Arbaprostil
Enprostil
Misoprostol
Rioprostil
Trimoprostil
Misoprostol is a prostaglandin analog used to reduce the
risk of NSAID related ulcers
Misoprostol is a synthetic prostaglandin E1 analog that
stimulates prostaglandin E1 receptors on parietal cells in
the stomach to reduce gastric acid secretion. Mucus and
bicarbonate secretion are also increased along with
thickening of the mucosal bilayer so the mucosa can
generate new cells.

24. 5. Antispasmodic:
• Antispasmodics (anticholinergics) reduce gastric secretions and mobility
while also reducing gastric spasm and slowing gastric motility.
• By retaining food in the stomach and limiting the quantity of stomach
acids secreted, these actions reduce the exposure of the delicate gastric
mucosa to HCl.
• GERD, ulcerative colitis, diverticulitis, biliary spasm, and irritable bowel
syndrome are all treated with these drugs.
“Muhammad Shahid”

25. Examples of antispasmodics are:
Dicyclomine (Bentyl)
Glycopyrrolate (Robinul)
They can be taken orally, but they can also be given as an
IM injection or an IV dosage in the case of glycopyrrolate.

26. Mechanism of action
● The mechanism of action is inhibition of calcium influx into the arterial
smooth-muscle cells.
● Anticholinergics are a broad group of medicines that act on the
neurotransmitter, acetylcholine. They are also called antispasmodics.
● By blocking the action of acetylcholine, anticholinergics prevent impulses
from the parasympathetic nervous system from reaching smooth muscle
and causing contractions, cramps or spasms.

27. 6. H2-receptor antagonists:
• H2-receptor antagonists are a class of medications that inhibit histamine from
attaching to parietal cells and causing them to secrete the stomach acid HCl.
• Some H2-receptor antagonists are
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Taladine, Zantac)
Cimetidine was the first H2 receptor antagonist however its utility is limited because of its
adverse effect profile and drug-drug interactions.
“SANIYA ILYAS”

28. ACTION
• H2RAs decrease gastric acid secretion by reversibly binding to
histamine H2 receptors located on gastric parietal cells, thereby
inhibiting the binding and activity of the endogenous ligand
histamine.
• H2 blockers are function as competitive antagonist.

29. Therapeutic uses
● All four agents are equally effective in promoting the healing of duodenal and
gastric ulcers.
● Patients with NSAID-induced ulcers should be treated with PPIs, because
these agents heal and prevent future ulcers more effectively than do H2
receptor antagonists.
● It is also used in prevention and management of acute stress ulcers.
● H2 blockers produce rapid and marked pain relief within 2-3 days.

30. ● After oral administration, the H2 receptor antagonists distribute widely
throughout the body and are excreted mainly in the urine.
● The elimination t1/2 is 2-3 hr.
ADVERSE EFFECTS
● Cimetidine can have endocrine effects, such as gynecomastia and
galactorrhea (continuous discharge of milk).
● H2 receptor antagonists may reduce the efficacy of drugs that require an
acidic environment for absorption.
● These can also cause CNS effects (confusion, mentation).
● Cimetidine inhibits several cytochrome P450 isoenzymes and can interfere
with the metabolism of many drugs.
PHARMACOKINETICS

31. 7. Proton-pump Inhibitors:
• Proton pump inhibitors (PPIs) are a class of antisecretory medicines.
• The hydrogen-potassium adenosine triphosphatase (ATPase) enzyme
system of the stomach parietal cells is inhibited by these medicines,
which reduce gastric acid secretion.
• The acid (proton) pump system is another name for the ATPase enzyme
system. Gastric acid secretion is suppressed by proton pump inhibitors,
which work by preventing the final stage in the synthesis of stomach
acid by the gastric mucosa.
“Usman Afzal”

32. The body absorbs proton pump inhibitors into the bloodstream. From
there, they send signals to the acid-forming cells in the stomach lining.
These tell the cells to reduce the amount of acid they produce.
Proton Pump Inhibitor
(PPIs) Mechanism:

33. Esomeprazole (Nexium)
Omeprazole (Prilosec)
are two proton pump inhibitors. Combination therapy for the
treatment of H.pylori infection in individuals with duodenal ulcers is
a common application of these medications.

34. ● Omeprazole is a selective and irreversible proton pump inhibitor. It
suppresses stomach acid secretion by specific inhibition of the H+/K+-
ATPase system found at the secretory surface of gastric parietal cells.
Because this enzyme system is regarded as the acid (proton, or H+) pump
within the gastric mucosa, omeprazole inhibits the final step of acid
production.
Omeparazole
Mechanism of action:

35. ● If you're overweight, lose weight.
● Stay away from foods that trigger you, such as coffee, chocolate, tomatoes,
fatty meals, and spicy foods.
● Have smaller meals throughout the day, and eat your evening meal 3-4
hours before bedtime.
● Quit smoking.
● Limit your alcohol consumption to the prescribed levels.
How to treat ulcer physically:

36. Natural Home
Remedies
for
Peptic Ulcer

37. Fruits, vegetables, and whole grains:
Foods containing the antioxidant polyphenols may protect you from ulcers and help ulcers heal.
Polyphenol-rich foods and seasonings include:
Dried Rosemary
Mexican Oregano
Dark Chocolate
Blueberries, Raspberries, Strawberries, Elderberries, And Blackberries
Black Olives

38. Honey
• Depending on the plant it’s derived from, honey can contain up to 200
elements, including polyphenols and other antioxidants.
• Honey is a powerful antibacterial and has been shown to inhibit H.
pylori growth.
• As long as you have normal blood sugar levels, you can enjoy honey as you
would any sweetener, with the bonus of perhaps soothing your ulcers.

39. Probiotics
Probiotics are the living bacteria and yeast that provide healthy and important
microorganisms to your digestive tract.
They are present in many common foods, particularly fermented foods.
These include:
Buttermilk
Yogurt
Kimchi
Studies have shown that probiotics may be helpful in wiping out H. pylori and
increasing the recovery rate for people with ulcers when added to the traditional regimen of
antibiotics.
“Muhammad Ussama”

40. Flavonoids
Flavonoids are compounds that occur naturally in many fruits and vegetables.
Foods and drinks rich in flavonoids include:
Soybeans
red grapes
Broccoli
Apples
berries
teas, especially green tea
These foods may also help the body fight against the H. pylori bacteria.
Flavonoids are referred to as “gastroprotective” which means they defend
the lining of the stomach and could allow ulcers to heal.

41. Thank you for
listening…
Any Question?