Peptic ulcer disease (PUD) is a consequence of the breakdown of the lining of the gastrointestinal tract. PUD is classified by ulcers in the stomach, duodenum or the esophagus. Some symptoms of PUD include bleeding, anemia, dysphagia (difficulty swallowing), and recurrent vomiting.   

PUD is can be a result from a bacterial H. pylori infection or NSAID painkiller overuse. The bacteria, H.pylori embeds itself into the protective mucosa of the stomach and duodenum, weakening it. H. pylori is able to survive acidic conditions because of the alkaline enzymes it secretes that neutralizes the acids and allows it to continue burrowing within the lining. NSAIDs, like aspirin, function by suppressing prostaglandin synthesis, resulting in decreased gastric mucosal blood flow which can eventually lead to damage of the mucosa. Additionally, a suppression of prostaglandin synthesis can result in increased gastric acid synthesis and decreased bicarbonate synthesis, further weakening the gastric lining defense. So in short, uncomplicated PUD can be merely treated by eliminating the H. pylori infection or decreasing the use of NSAIDs.

However, some cases of PUD are more complicated and require gastroprotectant drugs which can heal the mucosa, stabilize bleeding of the gastrointestinal tract and additionally protect the mucosa from further damage. Gastroprotectant drugs can be in the form of protonpump inhibitors (PPIs), prostaglandin analogues and histamine-2 receptor antagonist (H2RAs). PPIs are responsible for inhibiting the H+/K+-ATPase on parietal cells of the stomach, decreasing acid secretion. Prostaglandin analogues function similarly to prostaglandin and inhibit gastric acid secretion and additionally stimulate bicarbonate secretion.

In a study discussed by an article in The Lancet, PUD patients were assigned to either a prevention trial, healing trial or treatment of acute upper GI bleeding trial. Each trial group was randomly given either a PPI, prostaglandin analogue or H2RA.

In the prevention trials, gastroprotectant drugs reduced the development of endoscopic ulcers and upper gastrointestinal bleeding. In contrast to the other drugs, PPIs showed a more significant reduction in upper gastrointestinal bleeding. It was also found that PPIs were more effective than prostaglandin analogues and H2RAs when it comes to ulcer healing and protectiveness from further bleeding. Gastroprotectants, PPIs in particular, reduce the risk of peptic ulcer disease and its complications and promote healing of peptic ulcers in a wide range of clinical circumstances.

Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a metaanalysis of randomised trials. Scally, Benjamin et al.

The Lancet Gastroenterology & Hepatology

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