Medications for Stomach Ulcers

Stomach ulcers are a common problem that affects many people. Fortunately, there are various medications that can help treat and prevent ulcers. This article will provide you with an overview of the different types of medications used to treat stomach ulcers, including their mechanisms of action, indications, side effects, and precautions.

1. Groups of Medications for Stomach Ulcers

There are four main groups of medications used to treat stomach ulcers:

• Acid-reducing medications:

• Proton pump inhibitors (PPIs): These bind to the H+/K+ proton pump in the stomach lining cells, inhibiting its activity and significantly reducing gastric acid secretion (by 80-95%). Drugs in this group end in “-prazole” (e.g., omeprazole, lansoprazole).

• Histamine H2 antagonists: These competitively antagonize Histamine R2 receptors, inhibiting the release of gastric acid, particularly effective for nighttime acid secretion. Drugs in this group end in “-tidine” (e.g., cimetidine, ranitidine, famotidine).

• Antacids: These contain basic components and salts (Al(OH)3, Mg(OH)2, NaHCO3, CaCO3) to neutralize acid in the stomach.

• Gastric mucosal protectants:

• Sucralfate: This forms a protective layer on the gastric mucosa, inhibiting the activity of pepsin and promoting mucosal regeneration.

• Bismuth compounds: This coats the ulcer, creating a protective barrier against acid and pepsin, and stimulates mucus and bicarbonate production.

• Misoprostol: This is a synthetic prostaglandin E analogue that stimulates mucus and bicarbonate production, protecting the gastric mucosa.

2. Proton Pump Inhibitors (PPIs)

• Mechanism of action: Bind to the H+/K+ pump (inactive pump -> no H+ secretion).

• Efficacy: Strongest inhibition of gastric acid secretion (80-95%).

• Recommendation: Take 30 minutes before meals.

3. Histamine H2 Antagonists

• Mechanism of action: Antagonism, competitive inhibition of Histamine R2 (inhibits H+ secretion).

• Efficacy: Especially effective for nighttime acid secretion.

4. Antacids

• Mechanism of action: Neutralize acid in the stomach.

• Precautions: Drug interactions, may form insoluble complexes with other medications, hindering absorption.

5. Gastric Mucosal Protectants

• Sucralfate:

• Mechanism of action: Wound healing, pepsin inhibition, stimulation of prostaglandin production.

• Bismuth compounds:

• Mechanism of action: Coats the ulcer, protects gastric mucosa, stimulates mucus and bicarbonate production.

• Misoprostol:

• Mechanism of action: Stimulates mucus and bicarbonate production, protecting the gastric mucosa.

6. Indications and Side Effects of Medication Groups

Proton pump inhibitors (PPIs):

• Indications: Gastroesophageal reflux disease (GERD), stomach ulcers, esophagitis, H. pylori-induced ulcers, Zollinger-Ellison syndrome.

• Side effects: Bone fractures (long-term use), hypomagnesemia, vitamin B12 deficiency (elderly).

Histamine H2 antagonists:

• Indications: GERD, peptic ulcers, prevention of stress-related gastritis bleeding.

• Side effects: Cimetidine may have anti-androgenic effects, increase prolactin secretion leading to gynecomastia in men, and galactorrhea in women.

Antacids:

• Indications: Uncomplicated stomach ulcers, use after meals, severe symptoms, or uncontrolled GERD.

• Side effects: Flatulence, nausea, constipation, metabolic alkalosis, fluid retention, diarrhea (Mg), constipation (Al), hypophosphatemia (Al).

Gastric mucosal protectants:

• Sucralfate:

• Indications: Gastritis, GERD, prevention of stress ulcers.

• Bismuth compounds:

• Indications: H. pylori infection.

• Misoprostol:

• Indications: Prevention of NSAID-induced ulcers.

7. Considerations in Treating Stomach Conditions

• NSAID-induced peptic ulcers: Use H2 antagonists, PPIs, sucralfate, selective NSAIDs.

• GERD: Use PPIs.

• H. pylori infection: Use 3 or 4 medications: PPI + 2 antibiotics (clarithromycin, amoxicillin, metronidazole, tetracycline) or Bismuth + PPI/H2 antagonists + 2 of the 4 antibiotics.

8. Conclusion

The medications used to treat stomach ulcers are diverse, each with its own advantages and disadvantages. Choosing the right medication should be done by a specialist doctor based on the patient’s condition, individual characteristics, and other factors.

Note: This article is for informational purposes only and cannot replace the advice of a doctor. Always consult with your doctor before taking any medication.