Nursing Pharmacology Chapter 27:  Gastrointestinal Drugs

 Pathogenic Factors

• Peptic ulcer disease appears to result from an imbalance between aggressive factors (including gastric acid, pepsin and Helicobacter pylori) and protective factors including gastric mucus, bicarbonate, prostaglandins.

• Helicobacter pylori: the principal role in peptic ulcer pathogenesis

  • H. pylori:

    • Helicobacter pylori

      Immunohistochemical staining of Helicobacter pylori User:  KGL, 12/16/2005 https://commons.wikimedia.org/wiki/File:Immunohistochemical_detection_of_Helicobacter_(1)_histopatholgy.jpg

    • Causes active, chronic gastritis

    • Bacterial protein products appear damaging

    • Proteases and phospholipases produced by H. pylori degrade glycoprotein-lipid mucus layer complex

    • H. pylori is proinflammatory

  •  Management of H. pylori infection: clinical consequences

    • 15% relapse rate for duodenal ulcer (DU) following H. pylori eradication

    • 75% relapse rate for duodenal ulcer following treatment with H₂ receptor blockers only

• Other Pathogenic Factors:

  • Possible genetic factor in duodenal ulcer

  • Cigarette smoking

    1. Increased incidence of DU

    2. Decreased therapeutic response

    3. Increased mortality rate from DU

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.