Treatment of Peptic Ulceration and IBD Flashcards
Describe the physiology of gastric acid production
- in gastric mucosa
- folds (crypts) that increase surface area for more secretory production
- parietal cells form HCl and also release intrinsic factor
- chief cells release proenzymes like prorenin and pepsinogen
Describe the secretory function of parietal cells
- parietal cells have lots of canaliculi that increase surface area (and therefore increase secretory function)
- production of HCl require proton pump (therefore to decrease acid production, PPIs are used)
What are the 3 things that help secretion of stomach acid?
- gastrin (released by G-cells in antrum and duodenum)
- ACh (acts on muscarinic receptors on parietal and histamine-containing cells)
- histamine (acts on H2 receptors on parietal cells)
What are the symptoms of an acute H.Pylori infection?
- nausea
- dyspepsia
- malaise
- halitosis
Describe the pathogenesis of an acute H.Pylori infection
gastric mucosa is inflamed with neutrophils and inflammatory cells with a merked persistent lymphotcyte penetration
Describe the pathogenesis of a chronic H.Pylori infection
- local inflammation
- gastritis
What are the diagnostic tests for H.Pylori
- urea breath test
- stool antigen
- CLO (rapid urease test)
What is the first line treatment for H.Pylori?
- PPI and amoxicillin
- and either clarithromycin or metronidazole
- taken twice-daily for a week
(for non-penicillin allergic patients)
What are some examples of PPIs used to treat H.Pylori?
- esomeprazole
- lansoprazole
- omeprazole
- pantoprazole
- rabeprazole
What are some examples of histamine H2 receptor antagonists?
- rantidine
- cimetidine
What is the therapeutic approach to dyspepsia and GORD?
- lifestyle advice (healthy eating, weight reduction etc)
- avoid known precipitants (coffee, alcohol, chocolate, fatty foods)
- raise the head of the bed and have main meal well before going to bed
- avoid NSAIDs
- OTC remedies
- PPIs for symptoms
What are some examples of OTC medicines for dyspepsia and GORD?
- antacids (neutralises acid)
- alignates (increases adherence of mucus to oesophageal mucosa)
- simeticone (anti-foaming agent)
Describe the overall therapeutic approach to peptic ulcers
- endoscopies
- rapid urease test (for H.pylori)
- stop NSAIDs
- further investigation
- as well as lifestyle advice and medications
Describe the initial treatment for peptic ulcer disease
- H.Pylori positive: H.Pylori eradication
- NSAID associated:
- stop use of NSAIDs, give full dose of PPI or H2RA therapy for 8 weeks
- if H.Pylori then do eradication after
- H.Pylori ‘-‘ve’ and no NSAID: full dose PPU or H2RA therapy 4-8 weeks
What is IBD?
- blanket term for 2 conditions:
- Crohn’s (skip lesions - patchy, anywhere in GI tract)
- ulcerative colitis (starts in bowel and lesions extend)
