secretions cause mucosal damage. If gastric secretions increase to pH 5, pepsin
declines. The gastric mucosal barrier (GMB) is a thick, viscous, mucous lin-
ing and is a defense against corrosive substances. The two sphincter muscles—
cardiac and pyloric—act as barriers to prevent reflux of acid into the
esophagus and the duodenum. Esophageal ulcers result from reflux of acidic
gastric secretion into the esophagus as a result of a defective or incompetent
cardiac sphincter.
Gastric ulcers frequently occur because of a breakdown of the GMB.
Duodenal ulcers are caused by hypersecretion of acid from the stomach that
passes to the duodenum because of
- insufficient buffers to neutralize the gastric acid in the stomach.
- a defective or incompetent pyloric sphincter.
- hypermotility of the stomach.
Treatment of peptic ulcers is given in two-drug, three-drug, and four-drug
regimens, or a combination medication consisting of multiple drugs combined
into one package.
However, the American College of Gastroenterology no longer recommends
two-drug regimens since they are not as effective as other treatment regimens.
The different classes of medication that may be combined are listed below.
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Gastroesophageal reflux disease is an inflammation of the esophageal mucosa
caused by reflux of stomach contents into the esophagus. GERD is caused by a
malfunction of the esophageal sphincter brought about by smoking and obesity.
GERD is treated using common anti-ulcer drugs that neutralize the gastric
contents and reduce gastric acid secretion. Once the content is neutralized, the
esophageal mucosa has time to heal—freeing the patient of symptoms of GERD.
There are eight groups of anti-ulcer drugs used to treat GERD. These are:
Tranquilizers
Tranquilizers have minimal effect preventing and treating ulcers. However, they
reduce vagal stimulation and decrease anxiety. Librax is a commonly prescribed
tranquilizer to treat GERD. Librax is a combination of the anxiolytic chlor-
diazepoxide (Librium) and the anticholineratic clidinium (Quarzan) and is used
in the treatment of ulcers.
CHAPTER 18 Gastrointestinal System^341