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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