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Gastroenterology: Which are the popular Brands?

Antacids and Antiulcer Drugs: what are they?

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. This article explains in detail-Antacids and Antiulcer Drugs under gastroenterology.

As the name indicates, antacids are ‘anti-acids.’ Chemically, the drugs of this class are basic compounds that aid in neutralizing the released gastric acid and raise the pH of gastric contents. Under this condition, pepsin activity gets reduced if the pH rises above 4; since pepsin gets secreted as a complex with an inhibitory terminal part that dissociates below pH 5. The optimum peptic activity is in the pH 2 to 4.

Gastroenterology- Commonly prescribed medicines

Ranitidine: It reversibly binds to and antagonizes the histamine H 2
receptors located on the gastric parietal cells. This prevents the binding of
histamine to the receptors and reduces the secretion of gastric acid.

Domperidone: It blocks the peripheral dopamine receptors and facilitates
gastric emptying along with a decrease in the small bowel emptying time.
This is accompanied by an increase in the esophageal and gastric peristalsis
together with a reduction in the esophageal sphincter pressure. It also
blocks the dopamine receptors (D 2 and D 3 ) at the chemoreceptor trigger zone to elicit an antiemetic action and thereby suppresses nausea and vomiting.

Omeprazole: It selectively inhibits the H + K + ATPase enzyme system by covalently binding to cysteine residues on the alpha subunit of this pump. This, in turn, inhibits gastric acid secretion that occurs as a result of both basal and stimulated acid secretion. This drug is also known as proton pump inhibitors and used in the treatment for an ulcer.

Diastase: It is an enzyme that acts as a catalyst in the breakdown of starch
to disaccharide and trisaccharide maltose containing 1,4- linked and 1,6 –
glucose residues. It also aids in digestion.

Pepsin: It is a proteolytic enzyme that metabolizes proteins to peptides by
hydrolyzing the peptide linkages where one of the amino acids is aromatic.
It is responsible for less than 20 % of the protein digestion in the
gastrointestinal tract.

Magnesium hydroxide: As an antacid, it neutralizes the gastric acid
combining the hydroxide ions of the magnesium hydroxide with the
hydrogen ions of the gastric to form magnesium chloride and water. It also
exerts an osmotic effect on the gut by increasing the amount of water
drawn into this region. This in turn softens the stool, increases intraluminal volume, stimulates intestinal motility, and induces the urge to defecate.

Picosulfuric acid: It inhibits the absorption of water and electrolytes along with an increase in their secretion into the intestinal lumen. It is also
hydrolyzed by the bacterial enzyme, sulfatase, to form an active metabolite
that acts directly on the colonic mucosa to stimulate colonic peristalsis.

Dicycloverine/ dicyclomine: It directly inhibits muscarinic M 1 and M 2
receptors and non-competitively inhibit bradykinin and histamine. This in
turn relaxes the smooth muscles and decreases the strength of contraction
seen in spasms of the ileum.

Rabeprazole: It selectively and irreversibly inhibits H + K + ATPase pump that is found on the secretory surface of parietal cells. This in turn prevents the production of gastric acid via inhibition of the final transport of hydrogen ions in exchange for the potassium ions in the gastric lumen. Rabeprazole is a preferred choice in the treatment of an ulcer.

Simethicone: It decreases the surface tension of gas bubbles, facilitates
their coalescence and expulsion as flatulence or belching. It also facilitates
the movement of gas through the bowel lumen prevents the formation
and accumulation of mucous-enclosed gas pockets in the lumen and
reduces the frequency of flatus events.

Lactulose: It is minimally absorbed by the gut and mostly remains in the
gastrointestinal tract. Due to this, it enhances the stool amount and softens
the stool. It also enhances intraluminal gas formation, peristaltic gut motility, and elicits an osmotic effect for softening the stool to increase the
frequency of bowel movements in patients with constipation.

Saccharomyces boulardii: This organism along with the proteins it
secretes elicits anti-inflammatory effect by inhibiting the pro-inflammatory
cytokines through the nuclear factor-kB and mitogen-activated protein
kinases. It also activates the peroxisome proliferator-activated receptor-
gamma which in turn protects gut inflammation. Additionally, it suppresses bacterial overgrowth in the gut and stimulates antibody production against toxin A secreted by Clostridium difficile.

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References: other gastroenterology articles

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