Drugs Treatment of Peptic

Ulcer Disease

By

Dr. Nizamuddin Utmani MBBS, MCPS(Medicine), FCPS(Medicine)

MPH, CHPE, M.Phil(Pharma), Ph.D Pharma(Scholar)

Consultant Physician

Assistant Professor Pharmacology

• LOs.

• Classify the drugs used in Peptic ulcer

disease.

• Describe the mechanism of action of

drugs used in Peptic ulcer

Peptic ulcer

• Localised loss in gastric or duodenal mucosa,

exposing the submucosal structure.

Stomach Ulcers

Duodenal Ulcer

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Drugs for the treatment of peptic Ulcer

Disease

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• Mucosal Protective agents.

• H2 Blocker.

• PPI

Mucosal Protective Agents

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we have three main compounds in this group.

1.Sucralfate and other antacid.

2. Misoprostol.

3. Bismuth compound

Mucosal Protective Agents

• Sucralfate

• Combination of Sucrose and

Aluminium.

• In acidic PH, it is converted

into -ly Charged Sucrose

sulfate and Aluminium.

• The basic mechanism is

basically the binding of this -

ly Charged Sucrose sulfate

to +ly Charged Protein in

base of the Ulcer and thus

making a barrier.

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Pharmacokinetic, Dose

Mucosal Protective Agents

• 2. Misoprostol

• Gastric Mucosa secret PGE2

and Prostacyclin.

• Both decrease intracellular

cAMP and acid production.

• Misoprostol is an PGE1

analogue, which produce the

same effects in the stomach.

• Best drug for the prevention

of NSAIDs induced ulcer.

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• NSAIDs cause ulcers in 10-20% of the

user.

• Misoprostol decrease it to 3%.

• decrease ulcer complication by 50%.

• only popular in NSAIDs induced ulcers.

Mucosal Protective Agents

Mucosal Protective Agents

• 3.Bismuth

Compound

• There are two compound.

1. Bismuth Subsalicylate.

2. Bismuth Substrate

Potassium

• Bismuth Subsalicylate is

available in combination

with Metronidazole and

Tetracycline for H-Pylori

Eradication..

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Mucosal Protective Agents

• 3.Bismuth Compound

• Its is given for the Ulcer

prevention and Treatment.

• it can be given in watery

Diarrhoea, as Salicylate

decrease PG and Chloride

secretion, thus decrease the

water portion in secretory

diarrhoea.

• Bismuth also act directly as

antimicrobial, so kill the

microorganism in infective

diarrhoea.

• it also kill H-Pylori directly

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PPI

• Omeprazole. Safe

• Esomeprazole. Effective one.

• Rabeprazole. Safe in pregnancy

• Pantoprazole and dexlansoprazole. Safe in CV

Patients

Mucosal Protective Agents

• H-Pylori Eradication

Regimens

1. Standard.

PPI+Amoxycilline+Clarithr

omycin (Or Metronidazole

for 14 days (All BD).

2. PPI(BD)+ Bismuth

Subsalicylate(262mg-2

Tablets

QID)+Metronidazole(QID)+

Tetracycline(QID) for 10-

14 days.

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