ANTIULCEROGENIC AGENTS

2011

ANTIULCEROGENIC AGENTS (or ulcer-healing drugs) are used to promote healing of ulceration of gastric and duodenal peptic ulcers. A number of classes of drugs may be used. See also gastric secretion inhibitors.

First, the HISTAMINE H2-ANTAGONISTS are very effective and have considerable usage, e.g. cimetidine. famotidine, nizatidine and ranitidine. These agents decrease gastric acid secretion and promote healing and may be used to treat dyspepsia and oesophagitis of a number of etiologies. Acid production is also very effectively reduced by the newer agents, the proton pump inhibitors, e.g. omeprazole (see GASTRIC PROTON PUMP INHIBITORS).

Anticholinergic drugs are only really suitable in the case of agents that show some gastric-selectivity, e.g. pirenzepine and telenzepine (see muscarinic cholinoceptor ANTAGONISTS). They work by reducing the secretion of peptic acid by the stomach mucosa.

Some prostaglandin analogues are effective in protecting the mucosa, and are incorporated into some preparations of NSAIDs to offer concurrent protection (though they may cause unacceptable stimulation of the ileum), e.g. misoprostol. (see prostanoid receptor agonists) .

Bismuth-containing antacid preparations have been in use for a long time, but some of the bismuth chelates (e.g. tripotassium dicitratobismuthate) are of proven benefit in ulcer, and, though it is not clear how they work, there is some evidence of antimicrobial actions against a bacterial infection (Helicobacter pylori) associated with peptic ulcers.

Liquorice derivatives have a long history of use, and an extracted principle carbenoxolone is of proven value, and, though its mechanism of action is not clear, it is thought to work by effecting cytoprotection protective secretions. Some complexes, e.g. sucralfate (aluminium hydroxide and sulphated sucrose) may be of value.

The treatment of peptic ulcers is increasingly turning towards the eradication of Helicobacter pylori infection of the stomach, which is strongly causally associated with the gastric ulcer syndrome, with the objective of long-term alleviation. It is necessary to use a number of drugs in concert, e.g. omeprazole, metronidazole and/or amoxycillin. and tripotassium dicitratobismuthate. Recently, ranitidine bismuth citrate (ranitidine bismutrex) has been introduced for such treatment.