Stomach, peptic ulcer disease

The next major class of drugs for peptic ulcer disease is the mucoprotectants and other protective agents. Sucralfate (4.158) is a carbohydrate-based drug (chapter 8) which forms an impenetrable paste that adheres to the stomach lining defect, providing a protective barrier. Misoprostol (4.159) is a semisynthetic prostaglandin derivative that promotes mucus production. Carbenoxolone (4.160) has a mineralocorticoid-type action that also promotes mucus production. 

Bismuth compounds have been used in the treatment of peptic ulcer disease. They function by selective binding to the ulcer, coating it and shielding it from the effects of gastric acid. Bismuth may also have activity against bacteria such as Helicobacter pylori, shown to be a causative factor in peptic ulcer disease of the stomach. Bismuth has been administered as bismuth subsalicylate (8.95) or tripotassium dicitrato bismuthate. 

The growth in endoscopic procedures, with direct visualization of the interior of the stomach, has largely removed the need for the clinical laboratory to carry out the analysis of gastric contents. Situations remain, however, in which the laboratory continues to play a significant role in the diagnosis of gastric diseases and in monitoring the effectiveness of treatment. This section describes peptic ulcer disease and tests for Helicobacter pylori H. pylori) and the measurement of basal acid output from the stomach. 

Abstract Persistent colonization of the human stomach by Helicobacter pylori is a risk factor for the development of peptic ulcer disease and gastric cancer. Adhesion of microbes to the target tissue is an important determinant for successful initiation, establishment and maintenance of infection, and a variety of different candidate carbohydrate receptors for H. pylori have been identified. Here the different the binding specifities, and their potential role in adhesion to human gastric epithelium are described. Finally, recent findings on the roles of sialic acid binding SabA adhesin in interactions with human neutrophils and erythrocytes are discussed. 

Peptic ulcer disease (PUD) is a disease in which ulceration occurs in the lower esophagus, stomach (along its lesser curvature), the duodenum, or jejunum. These are all areas concerned with digestion, hence the name peptic. The most prominent symptom is gnawing pain that is relieved by food and alkali, but worsened by alcohol and condiments. Painless periods of remission can occur even without treatment. 

Medical therapy for GERD and peptic ulcer disease consists mainly of neutralizing stomach contents or reducing gastric acid secretions. 

Like prostaglandins, histamine regulates numerous processes, including acid and pepsin secretion in the stomach, heart rate and vasodilation. Histamine antagonists which prevent acid and pepsin secretion are clinically used to treat peptic ulcer disease (Table 6.1). 

Until recently, it was believed that excess stomach acid caused stomach ulcers. It has now been proved that the cause is instead a bacterial infection and that ulcers can be successfully treated with antibiotics. The 2005 Nobel Prize in Physiology or Medicine was awarded to Barry J. Marshall and J. Robin Warren for their discovery of the role of Helicobacter pylori in gastritis and peptic ulcer disease. 

The issue of surgery of the stomach had been confounded for years by the problems related to sepsis and lack of adequate anesthesia. As late as the end of the nineteenth century, Naunyn felt obligated to describe it as an autopsy in vivo. Nevertheless, by 1881, Billroth, Pean, and Rydiger had resected the stomach, and Wolfler had successfully developed the procedure of gastroenterostomy. By the beginning of the twentieth century, Moynihan had transformed the treatment of peptic ulcer disease into a unique surgical discipline. 

Alexander Berg (top right), the Chief of Surgery at Mount Sinai Hospital in New York, originally noted the presence of bacteria in stomachs he had resected for peptic ulcer disease (left) and proposed that a bacterial origin should be considered ... 

For millions of years prokaryotes have orchestrated their genetic players to produce survival strategies that overcome almost all ills that bacterial flesh is heir to. Infection of mammalian gastric mucosae by Helicobacter spp. is due to this organism s insistence on habitation of probably the most unfriendly environment in the mammalian body, the inside of the stomach. The eradication of H. pylori for treatment of peptic ulcer disease not associated with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids or severe stress is now accepted as part of medical treatment of this set of illnesses. Whether the infection should always be treated with violence is a point of discussion [1]. 

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