Gastroesophageal reflux disease (GERD) "Acid Reflux"

Chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus

Transient or permanent changes in the barrier between the esophagus and the stomach, may be due to incompetence of the cardia, transient cardia relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia.


Symptoms

Heartburn is the major symptom of acid in the esophagus, characterized by burning discomfort behind the breastbone (sternum)

- Esophagitis (reflux esophagitis) — inflammatory changes in the esophageal lining (mucosa)
- Difficulty swallowing (dysphagia)
- Chronic chest pain
- Cough, hoarseness, voice changes, chronic ear ache, nausea
- Sinusitis



H2-receptor Antagonists

- H2-receptor antagonists reduce secretion of gastric acid by blocking H2-receptors.

- Used in short-term treatment of active duodenal ulcers and prevention of ulcer recurrence.

- Also used for heartburn.

Examples of H2 Receptor Antagonist
Pepcid AC, Zantac, Axid

H2-receptor Antagonists: Adverse Effects

Common Adverse Effects: GI disturbances, headache, drowsiness, confusion, agitation, hallucinations, and reversible impotence

Serious Adverse Effects: cardiac arrhythmias and cardiac arrest after IV bolus dose


Proton Pump Inhibitors

Act by blocking hydrochloric acid production

Used to heal stomach and duodenal ulcers and relieve symptoms of GERD and esophagitis

Examples
Prevacid

Peptic Ulcers

Ulcer in an area of the gastrointestinal tract that is usually acidic and thus extremely painful

~80% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however only 20% of those cases go to a doctor

Caused by hyperacidity and excessive pepsin activity

Alcohol, caffeine, and smoking have been linked to peptic ulcers



Helicobacter Pylori(Bacteria that causes Ulcers)

1 H. pylori penetrate the mucus layer of host stomach and adhere the surface of gastric mucosal epithelial cells.

2 Produce ammonia from urea by the urease, and the ammonia netralize the gastric acid to escape from elimination.

3 Proliferate, migrate, and finally form the infectious focus.

4 The gastric ulcerization is developed by destruction of mucosa, inflammation and mucosal cell death.


(Click to enlarge)


Signs & Symptoms

Symptoms of a peptic ulcer can be:
Abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal
Bloating and abdominal fullness
Nausea, and lots of vomiting
Loss of appetite and weight loss;
Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.

Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

Antacids: Uses
Alkaline compounds that neutralize hydrochloric acid

Most commons contain aluminum hydroxide and magnesium carbonate

Common: diarrhea or constipation, anorexia, weakness, bone pain, tremors

Hypermagnesemia may produce nausea, vomiting, confusion, renal calculi, metabolic alkalosis, headache.

Example of Medications that treat Peptic Ulcer
Tums(Calcium Carbonate)
Milk of Magnesia (Magnesium Hydroxide)
Maalox Plus (Aluminum Hydroxide)

Drugs on the Gastrointestinal Disorders

This week, I will be discussing Medications for Gastrointestinal Medications.

Ulcers
Heartburn
GERD
Diarrhea
Constipation
Vomiting