Antacids And Anti-Ulcer Drugs

Acidity

The digestive juice in the stomach contains hydrochloric acid and an enzyme 'pepsin', which help in digestion of food. The wall of the stomach is protected from the action of the acid, by a lining called the 'mucus lining'.

When the mucus lining is damaged or when excessive acid production eats up the mucus lining, the stomach acid comes directly in contact with the stomach wall resulting in pain and inflammation. This disorder is known as Acidity. The symptoms of acidity include burning sensation in the stomach and/or chest regions, pain, indigestion, discomfort. Acidity may result from overeating, use of coffee and alcohol, smoking, anxiety, ingestion of certain foods/drugs.

Peptic Ulcer

When very large amount of acids are produced, the mucus lining is excessively damaged. This can lead to erosion of the underlying tissue resulting in 'ulcer'or 'peptic ulcer' ('peptic' word arising from the name 'pepsin', the stomach enzyme). The symptoms of peptic ulcer include pain, vomiting and loss of appetite. Peptic ulcer can occur in the oesophagus, stomach or duodenum (first portion of the intestine), the duodenum being the most common site of occurrence.

Causes

The exact cause of ulcer is not fully understood. However one of the causes appears to be hereditary. Those individuals who produce excessive stomach acids are prone to ulcers. Others who have normal acid production may develop ulcer because the protective mucus lining is defective or inadequate. Other factors which can increase the incidence of ulcer are:

-	Physical stress (burns, trauma, surgery)
-	Irregular eating habits
-	Anxiety, tension
-	Use of certain drugs and foods
-	Overuse of alcohol
-	Overuse of coffee
-	Heavy smoking

Certain drugs in use lead to excess acid production and on overuse result in ulceration. They include:

-	Alcohol
-	Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)
-	Aminophylline
-	Cortisone like steroids
-	Phenylbutazone

Treatment

A) Antiacidity
	They are used in acidity when simple remedies such as change in diet or a glass of milk fail to relieve the symptoms. Antacids combine with the stomach acid to reduce the acidity of the digestive juices. This helps to prevent pain and inflammation. Antacids are thus useful in the treatment of acidity. They are also used in the treatment of Peptic Ulcer as they relieve the pain (within a few minutes) and promote the healing of ulcer. However, they are not as effective as other anti-ulcer drugs.
Types of Antacids
The duration of action and speed of action of antacids varies as the type of antacids varies.
1.	Aluminum Compounds: They have prolonged action and are widely used. They can cause constipation and are hence combined with magnesium compounds, namely magnesium hydroxide to counteract that effect.
2.	Magnesium compounds: Magnesium hydroxides is widely used. It has prolonged action. It can cause diarrhoea. It is usually combined with aluminium Compounds. It should be used cautiously in patients with kidney problems.
3.	Sodium bicarbonate: It acts quickly but has short duration of action. It produces gas causing bloating in the stomach and belching. It should be avoided in heart and kidney patients.
4.	Combined preparations: Antacids are often combined with alginates and antifoaming agents, e.g., dimethicone. These additives have no primary benefit and just add up to the cost of the product.
Precautions
-	Do not take antacids on a regular basis without doctor's advice as it may suppress symptoms of some serious disease like stomach cancer.
-	Antacids interface with the absorption of many drugs. If you are taking other durugs, check with your doctor beforee taking an antacid.
B) Anti-Ulcer Drugs
	They are prescribed both to relieve the symptoms and to heal the ulcer. There is no drug to cure a tendency to ulcer formation. Hence courses of anti-ulcer drugs are repeated regularly (especially for duodenal ulcers). Surgery is needed only for complication such as uncontrolled bleeding, obstruction, and perforation.
Types of Anti-Ulcer Drugs
1.	H2 blockers: e.g., cimetidine, ranitidine, famotidine. A chemical called 'histamine' which when released by certain cells in the body produces a variety of effects, one of them being acid production in the stomach. The acid producing cells in the stomach has H2 (Histamine-2) receptors. The histamine binds with these receptors and triggers acid secretion. The H2 blocker drugs bind with the H2 receptors and thus prevent histamine from binding with them. This leads to reduction in acid production and ulcer healing.
2.	Bismuth and Sucralfate: They form a coating over the ulcer, protecting it from the action of stomach acid and allowing it to heal.
3.	Tranquilizers and Sedatives: May be used with anti-ulcer drugs to reduce anxiety and tension.

Precautions

Cimetidine and ranitidine are not prescribed for a period of more than 6 months. Cimetidine should be used cautiously in the elderly.

Sucralfate is prescribed for up to 12 weeks while bismuth is prescribed for courses of four weeks. It is important to drink plenty of water with bismuth. Sucralfate should be taken on empty stomach.