## Basic introduction
## Outline of the pathogenesis of peptic ulcers
_Helicobacter pylori infections in GIT
_Abnormality in secretion of gastric acid and pepsin
_Gastrinoma in Zollinger-Ellison syndrome.
_Mastocytosis [a rare disorder in which excessive number of mast cells are produced]
_Cholinergic hypersensitivity and parasympathetic dominance.
_An increase in parietal-cell mass
_Physiological imbalance between gastrin and somatostatin [which have antagonistic effects]
_Cigarette smoking and /or alcohol consumptlion
_Drugs such as NSAIDs, oral bisphosphonates, immunosuppressants.
## H. pylori is by far the most important cause of peptic ulcers (causing at least 95% of duodenal ulcers). These bacteria cause these ulcers by:
## Complications of Peptic Ulcer Disease
## Drugs that are used to treat dyspepsia, reflux and peptic ulcers are classified into the following categories:
## Therapeutics guided by Essential Drug List consideration
## Standard doses of drus in the Essential Drug List
_Sucralfate: 12 years and above: 2g BD [on rising and at bedtime] or 1g QID 1 hour before meals and at bedtime, taken for 4-6 weeks or in resistant cases up to 12 weeks; max. 8g daily. Child 1 month - 2 years 250mg 4-6 times daily, 2-12 years 500mg 4-6 times daily, 12-18 years 1g 4-6 times daily.
_Cimetidine: Benign gastric and duodenal ulcer: 400mg BD or 800mg at bedtime: long-term treatment: 400mg Nocte. Reflux oesophagitis: 800-1200mg divided into 2-4 daily doses. Zollinger Ellison Syndrome: 400mg QID or more. For hyperacidity, dyspepsia and heartburn: 100mg stat, repeat 100mg if symptoms persist for more than one hour.
_Famotidine: Benign gastric and duodenal ulcers treatment: 40mg Nocte 4-8 weeks. Maintenance: 20mg at night. Reflux oesophagitis, 20-40mg BD [6-12 weeks]. Zollinger-Ellison syndrome 20mg every 6 hours.
_Ranitidine: Peptic ulcer: 300mg nocte 4/52. Maintenance: 150mg nocte. Children over 18 years: 150mg BD. Not recommended for children below 8yrs. Zollinger-Ellison syndrome: 150mg TID up to 6g daily if necessary, in divided doses. Inj. Adults: 50mg by slow 1.V inj or inf. or I.M [repeat six or eight hourly].
_Esomeprazole: GERD without erosive esophagitis: 20 mg PO OD x 4 weeks, 20-40 mg OD IV up to 10 days, switch to PO once patient able to swallow. GERD with erosive esophagitis: Treatment: 20mg or 40 mg PO OD x 4-8 weeks. Maint: 20 mg PO OD up to 6 months, 20-40 mg OD IV up to 10 days, switch to PO once patient able to swallow. H. pylori eradication: Indicated for combination therapy [with amoxicillin and clarithromycin] to eradicate H. pylori in patients with duodenal ulcer 40 mg PO OD x 10 days, WITH amoxicillin 1000 mg PO BID, AND clarithromycin 500 mg PO BID x 10 days. Risk reduction of NSAID-associated gastric ulcer, 20-40 mg PO OD x up to 6 months. Zollinger-Ellison Syndrome, 60 mg PO OD [initial] up to 100 mg PO OD, OR 60 mg PO BID.
_Lansoprazole: Benign gastric ulcer: 30 mg daily in the morning for 8 weeks. Duodenal ulcer, 30 mg daily in the morning for 4 weeks; maintenance 15 mg daily. NSAID-associated duodenal or gastric ulcer: 30 mg OD for 4 weeks, continued for further 4 weeks if not fully healed; prophylaxis, 15–30 mg OD. Zollinger-Ellison syndrome [and other hypersecretory conditions]: initially 60 mg OD adjusted according to response; daily doses of 120 mg or more given in two divided doses. GERD: 30mg in the morning for 4 weeks, continued for further 4 weeks if not fully healed; maintenance 15-30mg daily. Acid-related dyspepsia: 15-30mg daily in the morning for 2-4 weeks. Child: body-weight under 30kg, 0.5-1 mg/kg [max. 15mg] once daily in the morning, body-weight over 30kg, 15-30mg OD in the morning.
_Omeprazole: Dose: Benign gastric ulcer; 20mg OD x 8/52. Benign duodenal ulcer; 20mg OD x 4/52. In severe cases doses are doubled. Reflux oesophagitis; 20mg OD x 4/52 or more. Zollinger Ellison Syndrome; 20-120mg daily [above 80mg]. It is given in two divided doses.
_Omeprazole / Sodium bicarbonate: Active duodenal ulcer for short term in adults: 20mg OD x 4 -8 wks. Benign gastric ulcer: 40mg OD x 4-8 wks. GERD: 20 mg OD for up to 4 wks. Erosive esophagitis: 20 mg OD for 4 - 8 wks.
_Pantoprazole: GERD: 40mg daily [up to 80 mg daily] for 4-8 wks. Gastric ulcer: 40mg daily [up to 80mg daily] for 4-8 wks. Duodenal ulcer: 40mg daily [up to 80 mg daily] for up to 4 weeks.
_Misoprostol: 200-800mcg QID.
_Esomeprazole/Clarithromycin/Amoxicillin: One set of daily dose daily for 7 days
_Lansoprazole/Clarithromycin/Amoxicillin: One set of daily dose daily for 7 days
_Lansoprazole caps: 30mg BD x 1/52. Amoxicillin caps: 1000mg BD x 1/52. Clarithromycin tabs: 500mg BD x 1/52.
_Lansoprazole/Clarithromycin/Tinidazole One set of daily dose daily for 7 days.