Medical Management of Acid-Peptic Disorders of the Stomach

Benign Disease of Stomach and Duodenum

“…Pepsinogen is converted to pepsin in the gastric lumen; it breaks down ingested proteins into smaller peptides. Pepsin has optimal activity at pH 2.5, but if the intraluminal pH rises above 5, pepsin becomes deactivated [6]. The body of the stomach also contains enterochromaffin-like cells (ECL) that express histidine decarboxylase.…”

“…The primary location of these cells is the antrum, but the body of the stomach and the duodenum also has D cells. Somatostatin inhibits the secretion of gastric acid, histamine, and gastrin [6].…”

“…PUD results from multiple factors that either injure the mucosal barrier in the stomach and duodenum or increase the production of gastric acid. In the healthy gastric mucosa, the mucus and bicarbonate form a hydrophobic pre-epithelial barrier that prevents backflow of H+ and maintains a neutral pH even with an increased intraluminal concentration of gastric acid [6]. Mucosal injury occurs regularly but is repaired by the mucosal defense system.…”

“…The healing rate is 70-80% in duodenal ulcers and 55-65% in gastric ulcers. The duration of therapy is the same as with PPIs [6]. An alternative in the treatment of PUD is sucralfate.…”

Gastroprotective and Ulcer-Healing Mechanisms of Ellagic Acid in Experimental Rats

“…Although the precise mechanisms of gastric ulcer formation are still being unraveled, the mechanisms by which some of the obnoxious agents bring about gastric ulcer have been partly revealed. H. pylori , known to be the major cause of active chronic gastritis, for example, has been shown to produce various cytokines that are related to neutrophil or mononuclear cell accumulation, including interleukins (IL) IL-1β, IL-6, and IL-8, interferon γ (IFN-γ), and tumor necrosis factor α (TNF-α) …”