Acid-pepsin disease

On the other hand, drugs may inhibit the metabolism of other drugs. For example, allopurinol (a xanthine oxidase inhibitor that inhibits the synthesis of uric acid) increases the effectiveness of anticoagulants by inhibiting their metabolism. Chloramphenicol (a potent inhibitor of microsomal protein synthesis) and cimetidine (an H2-receptor blocker used in acid-pepsin disease) have similar properties. In addition, drugs may compete with each other in metabolic reactions. In methyl alcohol (methanol) poisoning, ethyl alcohol may be given intravenously to avert methanol-induced blindness and minimize the severe acidosis. Ethyl alcohol competes with methyl alcohol for... 

Because acid-pepsin disease rarely occurs in the absence of gastric acid and pepsin, antacids are highly effective in its overall management. Antacids consist of a mixture of magnesium, aluminum, and calcium compounds. Their efficacy is based on their inherent ability to react with and neutralize gastric acid. Sodium bicarbonate, which may leave the stomach rapidly, can cause alkalosis and sodium retention. Calcium salts may produce hypercalcemia, which can be detrimental in patients with impaired renal function. Aluminum salts may decrease the absorption of tetracyclines and anticholinergic drugs. 

As a gastric secretagogue, alcohol stimulates the secretion of gastric juice, which is rich in acid and pepsin. Therefore, the consumption of alcohol is contraindicated in subjects with untreated acid-pepsin disease (Figure 68.2). In addition, alcohol releases histamine, which in turn releases gastric juice. This effect is not blocked by atropine. 

FIGURE 68.2 Ethanol aggravates acid-pepsin diseases. 

Aluminum hydroxide, an antacid with hypophosphatemic properties (5(X) to 18(X) mg p.o.), is indicated in acid pepsin disease and in hyperphosphatemia in renal failure (see Table 4). 

The use of heparin and other anticoagulants is contraindicated in the presence of active hemorrhage, potential hemorrhage (acid pepsin disease), and hemorrhagic disorders (hemophilia). 

Magaldrate, an antacid (540 mg between meals), by neutralizing gastric acid and inactivating pepsin, is used in the management of acid-pepsin disease. 

Metiamide, which was developed from burimamide by replacing a methylene group with an isoteric thio ether, is a histamine2-(H2) receptor antagonist with high specific activity, low toxicity, and good oral bioavailability in the treatment of acid-pepsin disease (see also Table 4). 

Acid-peptic disease Disease of the upper digestive tract caused by acid and pepsin includes erosions and uicers... 

Peptic ulcer disease (PUD) refers to a group of ulcerative disorders of the upper GI tract that require acid and pepsin for their formation. Ulcers differ from gastritis and erosions in that they extend deeper into the muscularis mucosa. The three common forms of peptic ulcers include Helicobacter pylori (HP)-associated ulcers, nonsteroidal antiinflammatory drug (NSAID)-induced ulcers, and stress-related mucosal damage (also called stress ulcers). 

We also determined the secretory patterns of blood group substances, HCl, and pepsin after histamine stimulation in 72 individuals with various diseases (G43). A statistically significant decrease was found in the titer of substances H and A after stimulation by histamine (Fig. 26). This was associated with a rise in acidity and frequently in pepsin concentration. Although the correlation of these data was not confirmed... 

Vitamin B] deficiency is commonly caused by pernicious anemia (PA). TA is an autoimmune disease resulting from the body s production of antibodies that recognize inlrinsic factor or other proteins of the parietal cell. The binding of antibodies to these proteins results in loss of their function. The parietal cells may be destroyed and be undetectable in patients with PA. The major defect in PA is gastric atrophy. 1 here may be a lack of all gastric secretions, including intrinsic factor, gastric acid, and pepsin. 

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