GERD_PPT胃食管反流英文版

Acid-Peptic Disorders
• Peptic Ulcer Disease –Occurs when there is an imbalance between the mucosal defense factors and the acid and pepsin.
Helicobacter pylori Infection
Causes of GERD
• Abnormalities with the Lower Esophageal Sphincter, or LES • Stomach Abnormalities – Hiatal hernia – Link
Causes
• Medications –NSAIDs –Calcium Channel Blockers (high blood pressure, angina)
• Causes 80% of peptic ulcers • Survives the acid environment by attaching to the sugar molecules that line the stomach wall • Uses the mucus layer as protection
NSAIDs
• Aspirin, Ibuprofen, Naproxen • Can have an affect at very low doses • Suppresses cylooxygenase-1 • Decrease production of prostaglandins
What is GERD?
Sucralfate (Carafate)
Proton Pump Inhibitors
• Proton pump inhibitors (PPIs) – Inhibits the gastric acid pump, H+/K+ ATPase – Are prodrugs
PPIs
• Diffuse into the parietal cells of the stomach and accumulates • Activated by proton-catalyzed formation of sulfenic acid • This prevents the drug from diffusing out • Activated form then irreversibly binds at the sulfhydryl groups of the cysteins of the H+/K+ ATPase • Link
Cysteine
PPIs
Rabeprazol (Acipex)
PPIs
Lansoprazole (Prevacid)
PPIs
Esomeprazole (Nexium)
PPIs
Omeprazole (Prilosec)
Omeprazole/sodium bicarbonate (Zegerid)
Treatments
• • • • • • • Antacids Alginates Sucralfate Proton Pump Inhibitors Histamine H2-Recptor Antagonists Prokinetics New Treatments
Antacids
• Quick but short term • Buffer gastric acid, increasing the pH • Neutralize acid by the following reaction
Agents to Treat Gastric Acidity and Gastroesophageal Reflux Disease (GERD)
Presented by Abby Roth
Overview
• Introduction – Symptoms • Causes – Peptic Ulcer Disease • H. pylori • NSAIDs – GERD • Treatments
Histamine
H2RAs
Cimetidine (Tagamet)
H2RAs
Nizatidine (Axid)
Other H2RAs
Famotidine (Pepcid)
Ranitidine HCl (Zantac)
Treatments
• Prokinetics –Increase LES function –Release stomach contents by • Activating serotonin receptors • Acting on dopaminergic receptors
Symptoms Continued
• Hoarseness • Sore Throat • Chest Pain • Bad Breath • Dry Cough • Asthma*
Symptoms in Children
• Vomiting • CoughinH)3 + 3 HCl AlCl3 + 3 H2O
Antacids
– Maalox • Al(OH)3 (aluminum hydroxide), Mg(OH)2 (magnesium hydroxide)
Antacids
• Tums • CaCO3 (calcium carbonate)
GERD vs. NERD
• Patients suffering symptoms are placed in two groups – Non-erosive reflux disease, or NERD – Erosive esophagitis • Erosive esophagitis is characterized by swelling and Inflammation – Barrett’s Esophagus – Precursor to Esophageal Cancer
Causes
• Smoking – Damages mucus membranes – Impairs muscle reflexes in the throat – Increases acid secretion – Reduces LES function and salivation
Causes
PPIs
Pantoprazole (Protonix)
Treatments
• Histamine H2-recptor antagonists (H2RAs) • The hormone, histamine stimulates the release of acid by interacting with the histamine receptor, or H2 receptor. • Inhibit acid secretion by competitively and reversibly blocking parietal cell H2receptors • Less potent then PPI’s
H. pylori
• Produce large amounts of urease
Urease H20 Urea
3 NH3 + CO2
H. pylori
• Secret proteins and toxins that interact with the stomach’s epithelial cells • Leads to inflammation and damage
• Condition where the stomach acid/content is pushed back or “refluxed” into the esophagus • Affects 10 million Americans • Approximately 7% have daily symptoms • Link
Medications
– Anticholinergics (urinary tract disorders) – Beta Adrenergic Agonists (asthma) – Dopamine (Parkinson’s disease)
Causes
• Food and Drinks – Carbonated beverages – Chocolate – Alcohol – Citrus Fruits – Coffee or Tea – Fatty foods – Containing tomatoes – Mint – Spicy Food
Alginates
• Polysaccharide found in the cell walls of brown algae • Sodium alginate is the sodium salt of alginic acid
Alginic Acid
Sucralfate
• Reacts with stomach acid to from a cross linked viscous polymer that acts as an acid buffer • Can bind to proteins on the surface of an ulcer to prevent further acid damage • Has been shown to aid in healing by promoting epidermal growth factors and prostaglandins
• Obesity • Laying down after a large meal • Eating close to bed time • Exercise