The lining of the stomach contains deep collections of cells organized into gastric glands. These gastric glands secrete various substances in the stomach.
The opening of the gastric glands into the surface of the stomach is called gastric pits.
1) Mucous Cells – They secrete mucus in the stomach
2) Parietal Cells – They secrete HCL
3) G Cells – They secrete gastrin, which increases the HCL production.
4) ECL Cells – These cells secrete histamine and chief cells secrete pepsinogen (an inactive form of the pepsin-digesting enzyme pepsin.
Intrinsic factors needed for the absorption of vitamin-b12 is also secreted by the gastric mucosa (most likely the parietal cells).
There are three pathways leading to acid production by the parietal cells
a) Acetylcholine – It is secreted at the sight, smell and taste of food.
b) Histamine is released as a result of swallowed food in the stomach.
When Acetylcholine, Gastrin or Histamine binds to its receptor on the parietal cell, a process is initiated that results in acid production.
ULCER: Ulcers are the perforations in the mucous membrane resulting from the hyperacidity, side effects of the drugs etc. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum.
Causes of ULCER:
- Excess alcohol
- Severe stress response
- Severe burns
- Extreme hyperacidity
- In Gastrin-secreting tumors (Zollinger-Ellison syndrome)
In 1982, two doctors – Barry Marshall and Robin Warren – discovered a certain kind of bacteria that can live and grow in the stomach. The medical name for these bacteria is Helicobacter pylori (or H. pylori, for short). Today doctors know that most peptic ulcers are caused by an infection from H. pylori.
Experts believe that 90% of the people around the world who have ulcers are infected with H. pylori. Peptic ulcers may have something to do with the combination of H. pylori infection and the level of acid in the stomach.
When H. pylori bacteria do cause ulcers, here’s how doctors think these ulcers develop:
- Bacteria weaken the protective coating of the stomach and upper small intestine.
- Acid in the stomach then gets through to the sensitive tissues lining the digestive system underneath.
- Acid and bacteria directly irritate this lining resulting in sores, or ulcers.
PEPTIC ULCER: A peptic ulcer is an open sore or raw area in the lining of the stomach (gastric) or the upper part of the small intestine (duodenal).
Duodenal ulcers :
- Increased acid levels
- Increased duration of normal acid secretion
- damage to surface epithelium
Symptoms : Stomach pain is the most common symptom of an ulcer. It usually feels like sharp aches between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for a while..
Other symptoms of ulcers can include:
- loss of appetite
- sudden, sharp stomach pains
- frequent belching
- weight loss
- vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)
- bloody or blackish bowel movements (this could indicate a serious problem, so call a doctor right away if you notice this)
Anyone who thinks he or she may have an ulcer needs to see a doctor. Over time, untreated ulcers grow larger and deeper and can lead to other problems.
Diagnosis of ulcer:
- One test to check for an ulcer is called an (upper gastrointestinal (GI) series). This is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a whitish liquid called barium while getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.
- Another common procedure to look for an ulcer is called an endoscopy (pronounced: en- dass-kuh-pee). During this test, the doctor uses an endoscope, a skinny, lighted tube with a special camera on the end.
- A doctor can also do a blood test for H. pylori bacteria. This may be important if an ulcer is found in the upper GI series or is suspected before the endoscopy.
- Sometimes a bowel movement or a person’s breath can also be specially tested to check for the H. pylori bacteria.
- Ulcers caused by H. pylori bacteria are generally treated with a combination of medications; usually two to three medicines are taken every day for a few weeks. Antibiotics are prescribed to kill the H. pylori bacteria. The other medicines – acid blockers or proton pump inhibitors – lessen the amount of acid in the stomach and help protect the lining of the stomach so the ulcer can heal.
Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylorus is responsible for the majority of peptic ulcers.
- pylori infection is common in the United States: About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.
Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.
How does H. pylori cause a peptic ulcer?
H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid
How are H. pylori peptic ulcers treated?
H. pylori peptic ulcers are treated with drugs that kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are used to kill the bacteria.
Two types of acid-suppressing drugs might be used:
H 2 BLOCKERS and PROTON PUMP INHIBITORS.
H 2 blockers work by blocking histamine, which stimulates acid secretion. They help reduce ulcer pain after a few weeks. Proton pump inhibitors suppress acid production by halting the mechanism that pumps the acid into the stomach. H 2 blockers and proton pump inhibitors have been prescribed alone for years as treatments for ulcers. But used alone, these drugs do not eradicate H. pylori and therefore do not cure H. pylori-related ulcers.
The use of only one medication to treat H. pylori is not recommended. At this time, the most proven effective treatment is a 2-week course of treatment called triple therapy.
Another option is 2 weeks of dual therapy. Dual therapy involves two drugs: an antibiotic and an acid suppressor. It is not as effective as triple therapy.
Two weeks of quadruple therapy, which uses two antibiotics, an acid suppressor, and a stomach-lining shield, looks promising in research studies. It is also called bismuth triple therapy
THE GASTRIC ACID SECRETION CAN BE REDUCED :
Antacids: They provide temporary relief, as they are not able to inhibit the factors that stimulate acid secretion e.g. Wisfast
Anticholinergics: These drugs are capable of inhibiting only Acetylcholine e.g. Pirenzipine
H2 receptor antagonists: These drugs are capable of inhibiting only Histamine e.g. Ranitidine
Proton Pump Inhibitors (PPIs): These agents provide complete control of acid secretion by inhibiting all the factors that stimulate acid secretion e.g. patoprazole
The final step in the acid secretion is an enzyme – the H+/ K+ ATPase (PROTON PUMP)) located on the surface of Parietal cells
These agents have the ability to block acid secretion by inhibiting this proton pump.
Mode of action of Domperidone –
- Domperidone stimulates gastrointestinal activity by acting as a competitive antagonist at Dopamine D2 receptors
- Drug, which promotes or increases coordination of contractions of gut wall.
- This action leads to enhancement of intestinal propulsion and gastric emptying.
- Dopamine inhibits gastrointestinal motility, reduces gastric and esophageal sphincter tone inhibits gastroduodenal coordination.
- A selective D2 antagonist like domperidone should reverse these effects.
Synergistic action of Pantoprazole and Domperidone
|Unmatched Acid Control||Promotes Contraction of gut wall|
|Prevents Acid Peptic Disorders||Enhances Intestinal Propulsion and Gastric emptying|
|Prevents Mucosal Damage more actively|
|Better cure rates|
- Reflux Esophagitis
- Heart Burn
- Nausea & Vomitting
Rationale of PANTOKART-D
Pantokart-D contains Pantoprazole 40 mg + Domperidone 30 mg. Its dose is 1 tablet OD (as recommended).
For nausea and vomiting associated with reflux esophagitis, dyspepsia and heartburn, the recommended dose of Pantoprazole is 40 mg, below than which it does not cure the symptoms.
Both Domperidone and Pantoprazole are absorbed orally and they are completely bio transformed and excreted in urine.
Composition: Pantoprazole- 40 mg (M.P.D.R)
SUSTAINED RELEASE FORMULATION
Sustained release tablet
Rate of absorption of a drug administered as a tablet or other solid oral dosage form is partially dependent upon its rate of dissolution in gastro intestinal fluids. The sustained release tablet produces slow, absorption of the drug for 8 hours or longer
Benefits of sustained release
a) Reduction in frequency of administration of drug so better dosage compliance as has to be given only O.D.
b) Maintenance of therapeutic effect overnight.
c) Decreased incidence of undesired effects so lesser side effects.
d) Convenient SR formulation allows right therapeutic dosages
Multi Pellet Drug Release technology is a form of sustained release technology with a advanced technology. In multi Pellet Drug Release Technology powder is turned into granules these granules are then converted into pellets by coating with the sustained release .Drug from these pellets gets released from these pellets slowly and steadily with time to work for around 24 hrs.
- Better patient compliance.
- Faster Absorption
- Better clinical efficacy
- Larger area of distribution
- Gastro Esophageal Reflux Diseases
- Nausea & Vomiting
- Functional Dyspepsia
- Erosive Esophagitis
- Incomplete Evacuation
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome is a brain gut disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people.
There are three types of IBS:
- a) IBS with Constipation – This comes with stomach pain and discomfort, bloating, abnormally delayed or infrequent bowel movement, or lumpy/hard stool.
- b) IBS with Diarrhea – This comes with stomach pain and discomfort, an urgent need to move your bowels, abnormally frequent bowel movements, or loose/watery stool.
- c) IBS with alternating constipation and diarrhea
What are the symptoms of IBS?
Abdominal pain, bloating, and discomfort are the main symptoms of IBS. However, symptoms can vary from person to person. Some people have constipation, which means hard, difficult-to-pass, or infrequent bowel movements. Often these people report straining and cramping when trying to have a bowel movement but cannot eliminate any stool, or they are able to eliminate only a small amount. If they are able to have a bowel movement, there may be mucus in it, which is a fluid that moistens and protect passages in the digestive system. Some people with IBS experience diarrhea, which is frequent, loose, watery, stools. People with diarrhea frequently feel an urgent and uncontrollable need to have a bowel movement. Other people with IBS alternate between constipation and diarrhea. Sometimes people find that their symptoms subside for a few months and then return, while others report a constant worsening of symptoms over time.
What causes IBS?
Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon (large bowel) that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.
- Normal motility, or movement, may not be present in a colon of a person who has IBS. It can be spasmodic or can even stop working temporarily. Spasms are sudden strong muscle contractions that come and go.
- The lining of the colon called the epithelium, which is affected by the immune and nervous systems, regulates the flow of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, when the contents inside the colon move too quickly, the colon looses its ability to absorb fluids. The result is too much fluid in the stool. In other people, the movement inside the colon is too slow, which causes extra fluid to be absorbed. As a result, a person develops constipation.
A person’s colon may respond strongly to stimuli such as certain foods or stress that would not bother most people.
Recent research has reported that serotonin is linked with normal gastrointestinal (GI) functioning. Serotonin is a neurotransmitter, or chemical, that delivers messages from one part of your body to another. Ninety-five percent of the serotonin in your body is located in the GI tract, and the other 5 percent is found in the brain. Cells that line the inside of the bowel work as transporters and carry the serotonin out of the GI tract. People with IBS, however, have diminished receptor activity, causing abnormal levels of serotonin to exist in the GI tract. As a result, people with IBS experience problems with bowel movement, motility, and sensation—having more sensitive pain receptors in their GI tract.
In addition, people with IBS frequently suffer from depression and anxiety, which can worsen symptoms. Similarly, the symptoms associated with IBS can cause a person to feel depressed and anxious.
Researchers have reported that IBS may be caused by a bacterial infection in the gastrointestinal tract. Studies show that people who have had gastroenteritis sometimes develop IBS, otherwise called post-infectious IBS.
The following have been associated with a worsening of IBS symptoms
- large meals
- bloating from gas in the colon
- wheat, rye, barley, chocolate, milk products, or alcohol
- drinks with caffeine, such as coffee, tea, or colas
- stress, conflict, or emotional upsets