Different types of drugs are employed in the management of peptic ulcer. The different groups of drugs each play a specific role in the healing of the ulcer or in helping to reduce the secretion of gastric juices. Diet control and surgery can also be involved depending on the type and stage of the ulcer. Some of the drugs for the management of peptic ulcer include:
1. Anbiotics: With recent knowledge that peptic ulcer is caused by a bacterium, antibiotics treatment is now being employed to get rid of the offending organism. In most cases there is the use of a combination of two different antibiotics which ensure the organism is completely destroyed.
2. Antacids: Antacids are used for the symptomatic relief of peptic ulcer pains. They help to neutralize the gastric acid and also inactivate pepsin. When given for a fairly long period they aid healing. One basic problem they have is that they may interfere with the absorption of other drugs employed in the treatment of the ulcer. It is therefore advisable to take antacids about 1hr before taking other medications or 2hrs after. Examples of antacids include: Magnesium hydroxide (Philip’s milk of magnesia); Magnesium hydroxide and Aluminium hydroxide (Gestid, Maalox and Mylanta); Aluminium hydroxide (Amphogel and Alternagel); Sodium bicarbonate and Calcium carbonate (Rolaids, Titralac, etc)
3. Histamine H2-receptor antagonists: They block histamine receptor thereby minimizing gastric secretions. Examples of these drugs are Cimetidine (Tagament), Ranitidine (Zantac), Nizatidine (Axid), Famotidine (Pepcid) etc
4. Proton-pump inhibitors: helps to decrease gastric acid production and as such limit the damage done by the gastric acid on the gastric mucosal lining. Examples of this drug include Omeprazole (Prilosec), Rabeprazole (Aciphex), Esomeprazole (Nexium), Pantoprazole (Protonix) and Lansoprazole (Prevacid).
5. Sedatives: May help to reduce stress and tension which are known to increase gastric secretion. These drugs include Diazepam and Phenobarbitone. They may be given in large doses at bed time.
6. Anticholinergics: They inhibit the action of acetylcholine thereby helping to reduce gastric acid secretion and also reduce pain. They may produce nasty side effects such as decreased visual acuity, difficulty in urinating and dryness of the mouth. Example of such drug is Pro-Banthine.
7. Sucralfate (Carafate): This drug helps to make a protective coating over the crater created by the ulcer thereby preventing further damage to the affected area.
8. Surgery: Surgery may be advocated if the use of drugs fail to control the acid secretion. Surgery could also be carried out when there is severe bleeding or perforation. Some of the surgical treatments include Vagotomy and Gastric resection (subtotal gastrectomy). Gastrectomy involves removal of the ulcer bearing part of the stomach, while vagotomy is to select the branches of the vagus nerve supplying the stomach and resect it to reduce gastric secretion and decrease gastric motility.
9. Patient education: Patient should be properly educated as to the cause of the disease, complications and their prevention; the need to adhere to the diet and drug therapy and the need to report signs of complication to the doctor. Patient should also be told to avoid NSAIDS, corticosteroids, alcohol, cigarette, caffeine, etc
10. Other methods of management may include the use of herbs, homeopathy and chiropractic.
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