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Medical Pharmacology Chapter 27: Gastrointestinal Drugs
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Peptic ulcer disease: an imbalance between aggressive factors (gastric acid and pepsin) and protective factors (gastric mucus, bicarbonate, prostaglandins)
Helicobacter pylori: a principal role in peptic ulcer
pathogenesis
H. pylori:
Causes active, chronic gastritis
Bacterial protein products appear damaging
Proteases and phospholipases produced by H. pylori degrade glycoprotein-lipid mucus layer complex
H. pylori presence is associated with proinflammatory effects.
Management of H. pylori infection: clinical consequences
15% relapse rate for duodenal ulcer following H. pylori eradication
75% relapse rate for duodenal ulcer following treatment with H2 receptor blockers only
Possible genetic factor in duodenal ulcer
Frequency of GU ulcers is about three times its common in first-degree relatives of DU patients compared to the general population; may however, reflect higher rate of H. pylori infection.
Cigarette smoking
Increased incidence of DU
Decreased therapeutic response
Increased mortality rate from DU
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Chronic renal failure |
Renal transplantation |
Systemic mastocytosis |
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Alcoholic cirrhosis |
Hyperparathyroidism |
Chronic obstructive pulmonary disease (COPD) |
Friedman, L. S. and Peterson, W.L. Peptic Ulcer and Related Disorders In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., and Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp. 1597-1616.
H.
pylori and
Carcinogenesis
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