Peptic ulcer is a common digestive tract disease, many friends ask Huazi, how to treat peptic ulcer? Huazi said that first, she should figure out the factors that induce peptic ulcer and eliminate it; second, under the guidance of a doctor, use drugs to treat it. In the process of medication, pay attention to the characteristics of 4 types of commonly used therapeutic drugs and use drugs rationally.
1. Factors that induce peptic ulcer
1. Helicobacter pylori (HP) infection:
The infection rate of Helicobacter pylori in Chinese residents is more than half, which is the main cause of peptic ulcer. Helicobacter pylori is the only known bacterium that can survive stomach acid. It can produce urease, break down urea to produce alkaline ammonia, neutralize stomach acid, and protect itself from being killed by stomach acid.
In the propagation process of Helicobacter pylori, it will also release vacuolar toxins, so that the cells of the gastric mucosa will produce vacuole degeneration, which will then cause damage to the gastric mucosa caused by an immune response, and the secretion of defense factors will be reduced, so that gastric acid and pepsin will cause their own digestion of gastric tissue.
2. Drug injury factors:
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, diclofenac, and indomethacin inhibits the activity of cyclooxygenase in the human body, resulting in a decrease in the synthesis of prostaglandin E.
Prostaglandin E can promote the repair and regeneration of gastric wall cells, increase the secretion of mucous membranes and bicarbonate, and increase the blood supply of gastric tissue, so when the synthesis of prostaglandin E is reduced, it will weaken the barrier of the digestive tract, and it is easy to be digested by gastric acid and pepsin.
There is also long-term large-scale use of glucocorticoids such as prednisone, dexamethasone, methylprednisolone, etc.; when antibiotics and anti-tumor drugs that stimulate the digestive tract are used, they will also cause gastric mucosal damage and induce peptic ulcers.
3. Genetic factors:
Normal people's stomach, there are about 1 billion gastric wall cells, but there are family genetic hyperacidity disease people, gastric wall cells can reach nearly 2 billion, gastric acid, pepsin secretion is much higher than normal people, easy to appear their own digestion and cause peptic ulcers.
4. Gastric emptying disorder:
If diseases such as pyloric sphincter insufficiency and gastrointestinal motility occur, the intestinal fluid in the duodenum will regurgitate into the stomach, which contains bile and pancreatic juice, causing damage to the gastric mucosa. Moreover, gastric emptying disorders will also cause food to stay in the stomach for too long, which will repeatedly stimulate the gastric wall to secrete gastric acid and pepsin, and it is easy to digest itself.
5. Endocrine disorders:
Long-term mental tension, smoking and other factors, will cause sympathetic excitement, autonomic nerve disorders, resulting in serotonin, catecholamine hormone release increased, so that the gastric and duodenal mucosa vasoconstriction, blood flow decreased, resulting in weakening of the digestive tract defense barrier, by their own digestion and ulceration.
In addition, in the case of trauma, surgery, sudden illness or mental trauma, sympathetic excitation and autonomic disorders can also occur, resulting in stress ulcers in the digestive tract.
Second, the treatment of peptic ulcer 4 types of drugs
The main cause of peptic ulcer is that the attack factors and defense factors in the digestive tract are out of balance, so the drug treatment strategy for peptic ulcer is to balance the relationship between the two, so as to relieve pain, promote healing, and prevent recurrence.
1. Antacid drugs:
Commonly used alkaline drugs such as sodium bicarbonate, magnesium oxide, magnesium trisilicate, aluminum hydroxide, and calcium carbonate. Using the alkaline nature of the drug itself, it can directly neutralize gastric acid and reduce the stimulation of stomach acid on its own tissues.
The ideal antacid drug should be rapid and long-lasting, non-absorption, non-gas production, no diarrhea or constipation, and have a protective and astringent effect on the mucous membrane and ulcer surface. However, it is difficult for a single drug to meet these requirements at the same time, so antacid drugs are often used to make compound preparations with multiple drugs to exert synergistic effects.
2. Drugs that inhibit gastric acid secretion:
Inhibiting gastric acid secretion is the main means of treating peptic ulcers. Pepsin increases its activity under acidic conditions, reduces gastric acid secretion, and can simultaneously inhibit the digestion of gastric acid and pepsin on its own tissues.
There are two major categories of drugs commonly used to inhibit gastric acid secretion, the first is H2 receptor blockers, such as cimetidine, ranitidine, famotidine and other drugs. It has a strong inhibitory effect on basal gastric acid secretion and nocturnal gastric acid secretion, reducing the acidity of the stomach, reducing the activity of pepsin, and promoting ulcer healing. Among them, the effect of famotidine is long-lasting, the ability to inhibit gastric acid secretion is the strongest, and the adverse reactions are the lowest.
The second category is proton pump inhibitors, such as omeprazole, lansoprazole, pantoprazole, rabeprazole and other drugs. The proton pump in gastric parietal cells is the final link in the production of gastric acid, and the proton pump inhibitor is highly selective to the proton pump in the gastric parietal cell, which can directly inhibit gastric acid secretion, has a protective effect on the gastric mucosa, and at the same time inhibits the activity of bacterial ATPase, and has a certain anti-Helicobacter pylori effect.
Two types of drugs that inhibit gastric acid secretion need to be taken on an empty stomach half an hour before meals, and the course of treatment for duodenal ulcer is 4 weeks, and the course of treatment for gastric ulcer is 6 to 8 weeks. Compared with the two, proton pump inhibitors are stronger than H2 receptor blockers in inhibition of gastric acid secretion and healing effects on the ulcer surface.
3. Protective drugs for the mucosa of the digestive tract:
Strengthening the defense of the mucous membranes of the digestive tract is also an effective way to treat peptic ulcers. The drugs used are mainly prostaglandin derivatives, such as misoprostol, enprostol and other drugs, which can increase the secretion of gastric mucus and bicarbonate, increase blood flow to the mucosa of the digestive tract, and enhance the barrier function of the digestive tract.
There are also bismuth-containing preparations, such as bismuth citrate potassium, colloidal pectin bismuth and other drugs, after taking it can be combined with gastric mucus to cover the ulcer surface, forming a protective layer; it can also promote the release of prostaglandin E, increase the secretion of mucus and bicarbonate; and can inhibit the activity of pepsin. It also has a killing effect on Helicobacter pylori, which can improve the local microcirculation of the gastric mucosa and promote the repair of epithelial cells. It should be noted that bismuth will stain the tongue and feces black, and when taken for a long time, bismuth absorption will be neurotoxic.
Sucralfate is also commonly used to protect gastric mucosa drugs, it should be noted that sucralfate needs to form a protective film in acidic conditions (PH, the formation of a viscous polymer on the ulcer surface, and can bind to pepsin to inactivate it. However, when the acidity in the stomach rises, it will fail, so sucralfate should not be combined with antacid drugs.
4. Anti-Helicobacter pylori drugs:
Helicobacter pylori releases urease and vacuolar toxins, causing damage to the mucous membranes of the digestive tract and is the main cause of peptic ulcers. People with peptic ulcers need to be tested for Helicobacter pylori infection, and those who are infected need to be cleared.
When testing for Helicobacter pylori, it should be noted that blood testing for Helicobacter pylori antibodies can only determine whether it has been infected with Helicobacter pylori, and it is not certain whether there is currently an infection. Clinical testing for Helicobacter pylori is usually performed with carbon-13 or carbon-14 breath tests, which is simple, fast, and highly accurate.
If Helicobacter pylori infection is confirmed, "quadruple" is now commonly used for clearance. The so-called "quadruple method" is to use 4 drugs to form a combination of drugs for treatment. The specific scheme is 1 kind of drug that inhibits gastric acid secretion (proton pump inhibitor is often selected), plus 1 kind of bismuth preparation, and then add 2 kinds of antibacterial drugs, and jointly carry out uninterrupted treatment for 10 to 14 days.
To sum up, most peptic ulcers can be cured with aggressive treatment. The key to treatment is two points, the first is to eliminate the cause; the second is to use drugs rationally. To do both, you need to go through the examination and diagnosis of a doctor before you can be treated. When taking drugs, we should pay attention to the characteristics of drugs and use drugs rationally under the guidance of doctors. Have doubts about medication, to consult a doctor or pharmacist in time, I am a pharmacist Huazi, welcome to pay attention to me, share more health knowledge.