1.

Introduction of ulcer
Etiology

General consideration: No Acid No Ulcer

Main Destroy Factors: HCl, Pepsin, Hp

Protective Barrier: Mucus-HCO3-

Physiology

HCl: P-cell, H2, M1, G-R, H+-pump

2. Peptic Ulcer
The term peptic ulcer refers to an ulcer in the lower Oesophagus, stomach,
duodenum (commonly), jujenum and ileum (rarely)

Gastric and duodenal ulcers may be acute

or chronic
Acute ulcer shows no evidence of fibrosis

Both penetrate the muscularis mucosae

Erosions do not penetrate the muscularis

mucosae

3. Production of Gastric acid

Secretion of gastric acid, mucus and bicarbonate. The control of the

gastrointestinal tract is through nervous and humoral mechanisms.

Acid is secreted from gastric parietal cells by a proton pump (K +/H+

ATPase).

The

three

endogenous

secretagogues

for

acid

are

histamine,

acetylcholine and gastrin.

Prostaglandins

E2

and

I2

inhibit

acid,

stimulate

mucus

and

bicarbonate secretion, and dilate mucosal blood vessels.

The genesis of peptic ulcers involves:

infection of the gastric mucosa with Helicobacter pylori.

an imbalance between the mucosal-damaging (acid, pepsin) and the

mucosal-protecting agents (mucus, bicarbonate, prostaglandins E 2
and I2

4. H-2 Reseptor Antagonist

Pharmacotherapeutics:

Used therapeutically to:

Promote healing of duodenal and gastric ulcers.

Provide long-term treatment of pathological GI hypersecretory conditions.

Reduce gastric acid production and prevent stress ulcers.

Unwanted effects are rare

5. Proton Pump Inhibitors
Pharmacotherapeutics:

Indicated for:

Short term treatment of gastric ulcers

Active duodenal ulcers and peptic ulcers (H. pylori)

Erosive esophagitis

GERD

Hypersecretory states

Unwanted effects of this class of drugs are uncommon. They may include
headache, diarrhoea (both sometimes severe) and rashes. Dizziness, somnolence,
mental confusion, impotence, gynaecomastia, and pain in muscles and joints have
been reported. Proton pump inhibitors should be used with caution in patients with
liver disease, or in women who are pregnant or breast feeding. The use of these
drugs may 'mask' the symptoms of gastric cancer.
6. Antimuscarinics Drugs

M1 receptors antagonists : Pirenzepine, telenzepine (a more potent analog),

reduce gastric acid secretion with fewer adverse effects than atropine and
others.

Contraindicated in some gastric ulcers as they may slow gastric emptying and
prolong the exposure of the ulcer bed to acid.

7. Antacids
Pharmacotherapeutics:

Prescribed to relieve pain and promote healing in peptic ulcer disease.

Also used to relieve symptoms of acid indigestion, heart-burn, dyspepsia, or

GERD.

Also used to prevent stress ulcers, GI bleeding, and hyperphosphatemia in kidney

failure.

8. Mucosal Protective Agents

Sucralfate is a complex of aluminium hydroxide and sulfated sucrose, which
releases aluminium in the presence of acid. The residual complex carries a strong
negative charge and binds to cationic groups in proteins, glycoproteins, etc. It can
form complex gels with mucus, an action that is thought to decrease the
degradation of mucus by pepsin and to limit the diffusion of H +.
Sucralfate can also inhibit the action of pepsin and stimulate secretion of mucus,
bicarbonate and prostaglandins from the gastric mucosa. All these actions
contribute to its mucosa-protecting action.
Unwanted effects are few, the most common being constipation, which occurs in
up to 15% of patients treated. Less common effects include dry mouth, nausea,
vomiting, headache and rashes. It should be used with caution in pregnancy, when
breast feeding, or in patients for whom enteral feeding is in progress

9. Prostaglandins Analogue
Prostaglandins of the E and I series have a generally protective action in the
gastrointestinal tract, and a deficiency in endogenous prostaglandin production
(after ingestion of a NSAID, for example) may contribute to ulcer formation.
Misoprostol is a stable analogue of prostaglandin E 1. It is given orally and is used
to promote the healing of ulcers or to prevent the gastric damage that can occur
with chronic use of NSAIDs.
Unwanted

effects

include

diarrhoea

and

abdominal

cramps;

uterine

contractions can also occur, so the drug should not be given during pregnancy
(unless deliberately to induce a therapeutic abortion
10.

Obat antiemetic