• Peptic ulcer, a lesion or sore develops on the lining of the GI tract, including – the oesophagus, stomach or small intestine.
• Peptic ulcers occur due to an imbalance between the secretion of acid, pepsin, bile and gastric mucosal defence.
• An ulcer found in the stomach is called a gastric ulcer and an ulcer found in the duodenum is called a duodenal ulcer.
• Gastric ulcer cause pain after meals and duodenal ulcer pain relieve after meals.

Peptic ulcer drugs

1. To reduce gastric acid secretion

   1. H2 – blockers drugs – H2 – blockers drugs taken empty stomach at night to treat peptic ulcer.

To block the action of the H2 receptor and prevent the action of histamine on parietal cell

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To reduce the gastric secretion

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Also reduce the pepsin activity

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Peptic ulcer healing is faster.

Peptic ulcer Drugs are 

• Ranitidine – 150 – 300 mg tablet (Rantac).
• Cimetidine – 200 mg.
• Famotidine – 20 – 40 mg.
• Roxatidine – 75 – 150 mg.

Uses 

• Duodenal and gastric ulcer
• Gastroesophageal reflux disorder
• Stress ulcer.

2. Proton pump inhibitors – 

The drugs are more potent inhibitors of acid secretion in the stomach. It is a more effective and more usable drug that is taken one hour before the meal.

Proton pump inhibitors Mechanism of action

Proton pump inhibitors drug

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Block the H+, K+ ATPase pump

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Inhibit the gastric acid secretion.

• Drugs
  • Omeprazole – 20 – 40 mg capsule / injection.
  • Pantoprazole – 40 mg.
  • Esomeprazole – 20 – 40 mg.
  • Lansoprazole – 15 – 20 mg.
  • Rabeprazole
  • Dexlansoprazole.

• Uses

• Gastric ulcer and duodenal ulcer.
• Gastroesophageal reflux disorder (GERD)
• Stress ulcer
• Zollinger – Elinson syndrome (Z – E syndrome).

3. Prostaglandin analogue 

• Misoprostol – 200 ug.

4. Anticholinergic drugs – It is a selective M1 receptor blocker.

• The drug block the gastric M1 receptors and inhibits the gastric secretion.
• Drugs

• Pirenzepin – 100 – 150 mg.
• Propantheline – 15 – 30 mg.
• Telsnzepine.

2.   To neutralize the gastric acids

• Antacids – Antacids is a chemical substance which is react with gastric acid and inhibit the gastric contents activities.

• It is an insoluble substance, that useful to relieve pain and treat peptic ulcer.

• Mechanism of action – It neutralizes the gastric acid and inhibit the gastric acid secretion.

Drugs 

• Systemic drug – Sodium bicarbonate drug.

• 1 – 5 gm orally.

Non-systemic drug 

• Aluminium hydroxide – up to 1 gm.
• Magnesium hydroxide – 0.5 – 1 gm.
• Calcium carbonate – up to 1.5 gm orally.
• Magnesium carbonate – 250 – 500 gm orally.

• Uses

• Gastric and duodenal ulcer.
• Indigestion, gastritis, heartburn.
• Peptic ulcer pain and burning.

• Adverse effects

• Constipation, hypermagnesemia, diarrhoea
• Hyperphosphatemia, alkalosis.

3.  Anti H – pylori Drugs – Helicobacter pylori is a Gram negative bacteria, and most common cause of peptic ulcer.

• The drug take empty stomach.
• Drugs
• Amoxicillin
• Clarithromycin
• Bismuth subsalicylate
• Metronidazole
• Tetracycline

Key Points

1. A lesion or sore develops in the lining of GI tract – Peptic ulcer
2. Which peptic ulcer causes pain after meals – Gastric ulcer
3. Which drug is useful to neutralize the gastric acid – Antacids
4. Most common cause of peptic ulcer – H. Pylori