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Parietal Cells Regulated by…
Neuronal: Seeing food, thinking food, stomach starts making acidity
Paracrine: Detects stretch/content in the stomach to start making acidity
Endocrine: Gastrin (most potent activator) triggered by protein in meal
Stomach protection
Physical Barrier: Gastric mucosa
→Stimulated by prostaglandins
Chemical barrier: Bicarb
Biological barrier: Restitution of the cellular layer
Environmental barrier: Blood glow
Pancreas Exocrine vs Endocrine tissue
Exocrine tissue: Majority of pancreas, secretes bicarb and digestive enzymes
Endocrine tissue: 2% of pancreas, secrete hormones into blood
What cuases Peptic ulcers?
NSAIDs
H Pylori
Acid hypersecretion
Cigarettes caffeine alcohol, glucocorticoids
Acid Neutralizers
Aluminum or Magnesium Hydroxide
Sodium Bicarb
Calcium carbonate
Acid neutralizer side effects
Mg: Diarrhea
Ca& Al: constipation
Sodium- caution HTN
H2 receptor antagonists
Block release of histamine from ECL cell
Cimetidine, Ranitidine, Famotidine, nizatidine
Proton pump inhibitors
omeprazole , pantoprazole
Metabolized by CYPs
Rabeprazole and Lansoprazole have a faster osnet
Class C pregnanacy
Agents that protect mucosa
Prostaglandin analogues
Misoprostol
Good for NSAID-induced ulcers
Contraindicated in women trying to get pregnant
Coating agents
Sucralfate
Forms a feel that coats epithelial cells and ulcer craters
Agents that treat H Pylori
Amoxicillin, tetracycline, metronidazole, clarithromycin
Triple therapy: Amoxicillin, clarithromycin, PPI
Quadruple therapy
Tetracycline, metronidazole, PPI, bismuth
Mesalamine
Inhibits inflammatory mediators by inhibiting activity NF-KB
Treat IBD
Pharmacotherapy in IBD
1)Mesalamine
2)Glucocorticoids
3)Immunosuppressive agents
4)Biologics
5)Antibiotics & Probiotics
6)Fecal Microbiota transplant
Immunosuppressive agents for IBD
Thiopurines
Methotrexate
Cyclosporine
Thiopurines
Impair purine biosynthesis and limit cell proliferation
Ex: Azathioprine
Methotraxate
Inhibit dihydrofolate reductase and blocks synthesis of DNA
(reserved for steroid resistant ot dependent)
Cyclosporine
Cacineurin inhibitor which prevents transcription of IL2
Reserved for steroid resistant UC or fistulous CD
Anti TNF biologics
Infliximab
Adalimumab
Certolizumab
Anti integrin biologics
Natalizumab
What antibiotics for IBD
Metronidazole
Ciprofloaxacin
Clarithromycin
Meds for IBS
Alosetron- 5HT3 antagoinst for diarrhea
Tegaserod- 5HT4 agonsit for constipation