1 / 20

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

walden
Download Presentation

Therapy ulcer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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

More Related