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Therapy ulcer

Therapy ulcer. of peptic. Peptic Ulcer. benign defects of mucosa of stomach / duodenum = mucosal damage through the muscle layer lamina muscularis mucosae Ethiopatogenesis : balance disorder: HCl, pepsine, bile acids

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Therapy ulcer

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  1. Therapy ulcer of peptic

  2. Peptic Ulcer • benign defects of mucosa of stomach / duodenum = mucosal damage through the muscle layer lamina muscularis mucosae Ethiopatogenesis:balance disorder: HCl, pepsine, bile acids –– protective factors of mucosa Klinical symptoms: stomach - significant pain in epigastrium shortly after meal, nausea, anorexia duodenum – later after meal, pyrosis

  3. Ethiopatogenesis • Helicobacter pylori – enzyme production • pept. ulcer of stomach: ext. factors salicylates, NSAID, glucocorticoids dietary mistakes, smoking prevalence: 2 – 5% /often duod. ulcers/ genetic factors = familiar incidence

  4. Benign Stomach Ulcer

  5. Diagnosis and Nonpharmacolog. Treatment • ezophagogastroduodenoscopia histologic check of nature of the ulcer lesions presence of HP= microscopy histo-morfologic rapid urease test non-invasive breath test serolog. antibody testing dif.dg: Zollinger – Ellison´s syndrome /gastrin/ complex treatment = nonpharmacol. therapy: lifestyle / sleep, stress /diet / oft, no spicy, no caffeine/ no smoking

  6. Endoskopic Pictures of Duodenal Ulcer

  7. Peptic Ulcer of Duodenum

  8. Pharmacotherapy of Ulcer Disease • one of the most frequently used in medicine • anti-infectives /ATB, chemotherapeutics/ • antisecretory drugs - reduce gastric acidic secretion:antagonists of H2 receptors proton. pump inhibitors • antacids – neutralisation of HCl • substances with gastroprotective effects prostaglandines, sucralfate

  9. Helikobacter Pylori - black bacterias of HP on the top of gastric mucosa

  10. HP Infection Eradication Therapy condition for the success of complex pharmacotherapy 1st line treatment: triple-combination 7-day administration of • Omeprazole 2x20 mg /lanzoprazole 2x30 mg/ • Clarithromycin 2x500 mg, till50kg-2x250 mg • Amoxicillin 2x1000 mg if allergy - metronidazole 2x500 mg

  11. Eradikcation of HP 2nd line treatment: combination of 4 drugs 7-day administration • Omeprazole 2x20 mg/Lanzoprazole 2x30 mg/ • Bismuth subcitrate 4x120 mg • Metronidazole 2x500 mg • Doxycykline 1x100 mg

  12. Antacids and Gastroprotective Drugs • Antacids:aluminum and magnesiumhydroxide = binding HCl and gastroprotection / release of prostaglandins / !! interactions /absorbtion/ !! renal insufficiency • Bismuth – !neurotoxicity, metallic taste, standardly nowadays used less

  13. Prostaglandines = Mucoprotectives • Prostaglandines/misoprostol, enprostil/ - cytoprotective and mucoprotective effect /improve mucosal microcirculation + create a protective barrier + regenerative processes / - treatment of chronic resistant ulcers induced by prolonged treatment with antirheumatic drugs and salicylates

  14. Sukralfate = Mucoprotective Drug Sukralfate /Al/: • sulfonated sucrose on mucosa and at the base of ulcer forms a protective layer that prevents the action of aggressive factors • suspicious stimulation of protective prostaglandin production • good tolserance • 4x1g daily • !no H2 receptor antagonists!

  15. Proton Pump Inhibitors • basic pharmacotherapy for peptic ulcer • the most effective antisecretoric substances • independently on the origin of secretion stimulus • ireversible inhibition in the last phase of secretion = on the proton pump level • MA: block. of proton. pump H/K-ATPase • “prodrug“ - in pariet. cells of gastric mucosa active metabolite • doesn´t affected. secr. of pepsin, but the change in gastric content pH reduces the conversion pepsinogen – pepsin

  16. Proton Pump Inhibitors Omeprazole:complete blockade at rest and stimulus, high therapeutic effect, 4-6 weeks therapy with 90% efficiency, suppresses helikobacterial infection drug interactions: diazepam, phenytoin, warfarin Pantoprazole, Lanzoprazole: less interactions, suitable at polymorbidities at older patients Esomeprazole: inovated omeprazole with faster onset and longer duration of action / 1x daily /

  17. H2 Receptor Antagonists • in stomach at all stages decreases formation of HCl by selective blocking of H2 receptors • therapeutic effect after 4 weeks - 60 -80% efficiency, after 8 weeks even 90%, 10-15% resistance Ranitidine, Famotidine /more effective/, Nizatidine: /1- 2x daily/ - good pharmacokinetic /p.o. absorbtion, metabolism in liver/ and safety profile, good tollerance - long-term maintenance therapy after uncomplicated peptic ulcer healing and treatment of some forms of gastric dyspepsias

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