Presentation on Medicines for GORD and Peptic Ulcers

Presentation on Medicines for Gastroesophageal Reflux Disease (GORD) and Peptic Ulcers

Introduction

  • Presenter: Chris Wakefield
  • Topic: Medicines used in the treatment of gastroesophageal reflux disease (GORD) and peptic ulcers.
  • Classes of medicines covered:
    • Antacids
    • Histamine II Receptor Antagonists
    • Proton Pump Inhibitors

Acid Production and Movement in the Stomach

  • The stomach is lined with parietal cells.
    • Function: Produce hydrochloric acid (HCl).
    • Contains histamine II receptors: When histamine binds to these receptors, it stimulates parietal cells to produce hydrochloric acid.
    • Proton pumps: Special transport systems that transport hydrochloric acid out of parietal cells into the stomach.
  • Hydrochloric Acid Properties:
    • Highly acidic, leading to a stomach pH of about 1.5 to 3.5.
    • This acidity is responsible for symptoms in dyspepsia, GORD, and peptic ulcer disease.

Antacids

  • Definition: Alkaline substances or weak bases that neutralize hydrochloric acid in the stomach.
  • Effect on pH: Raises gastric pH to an almost neutral range of 6 to 7.
  • Purpose: Provide symptomatic relief for dyspepsia, GORD, and peptic ulcers.
  • Tolerance: Generally well tolerated; however, side effects may include:
    • Constipation or diarrhea (depending on formulation)
    • Abdominal discomfort
    • High magnesium levels in the blood if magnesium-containing antacids are taken in excessive amounts.
  • Example: Mylanta
    • Common antacid, often initiated by nurses in healthcare settings.
  • Important Consideration:
    • Antacids can reduce the effectiveness of other orally administered medications.
    • Recommendation: Administer antacids at least two hours apart from other medications to avoid drug interactions.

Histamine II Receptor Antagonists

  • Functionality: Block or antagonize histamine II receptors on parietal cells, reducing hydrochloric acid production.
  • Indications: Used for treating dyspepsia, GORD, peptic ulcers, and stress ulcer prevention.
  • Adverse Effects: Infrequent or rare side effects.
  • Example: Ranitidine
    • Mechanism: Works by blocking the production of hydrochloric acid in parietal cells, thus reducing acid content in the stomach.

Proton Pump Inhibitors (PPIs)

  • Definition: Medications that inhibit the function of proton pumps in the stomach, which transport HCl.
  • Indications: Effective for treating dyspepsia, GORD, peptic ulcers, and adverse effects related to NSAIDs (non-steroidal anti-inflammatory drugs).
  • Adverse Effects: Generally mild, often presenting as gastrointestinal upset.
  • Example: Esomeprazole

Conclusion

  • Summary of key classes of medicines in the treatment of GORD and peptic ulcers:
    • Antacids: Alleviate symptoms by raising pH.
    • Histamine II receptor antagonists: Reduce acid production by blocking receptors.
    • Proton Pump Inhibitors: Inhibit acid transport into the stomach to minimize overall acidity.
  • Thank you for listening to the presentation.