6. Dyspepsia GERD Peptic Ulcer Gastritis
⢠Abnormal function ⢠Defect in ⢠Inflammation
(dysfunction) of the gastrin of lining of
muscles of the production the stomach
organs of the regulation -> ⢠Caused by:
gastrointestinal induction of Alchol
tract acid Sever
⢠May be functional production infection
or organic from parietal NSAIDS
(ulcerative)
cells ->
erosion of
mucosa ->
ulcer.
⢠Caused by :
H.Pylori
NSAIDS
7. Dyspepsia GERD Peptic Ulcer Gastritis
⢠heart burn ⢠Heartburn ⢠Abdominal ⢠Burbing
⢠Regurgitation pain
⢠Early satiety ⢠Dysphagia increased ⢠Bloating
⢠Odynophagia by food
⢠Flatulence ⢠Increased ⢠Loss of ⢠Unexplained
salivation appetite weight loss
⢠Fullness ⢠Nausea ⢠Heart burn
⢠Chest pain ⢠N&V ⢠Yellow ,
⢠N&V ⢠Asthma false green or
symptoms ⢠May lead to bloody
⢠Epigastirc pain perforation vomiting
14. Esomeprazole vs. Omeprazole
ď§ esomeprazole is the s-enantiomar of omeprazole (racemic
mixture)
ď§ less first pass metabolism -> higher bioavailability -> more
effective and longer lasting acid blockage -> 24 h interval
ď§ Esomeprazole has increased antimicrobial activity
against Helicobacter pylori than omeprazole.
ď§ most of the esomeprazole metabolized by slower acting 3a4
enz, and the remaining metabolized by fast acting 2c19 , also it
binds irreversibly to proton pump inhibiting acid secretion
Journal of Clinical Gastroenterology: July 2004 - Volume 38 - Issue 6 - pp 503-506
19. Indication
⢠Treatment GERD
⢠Dyspepsia
⢠H.Pylori (in combination with clarithromycin or amoxicillin)
⢠Healing and maintenance of Erosive esophagitis
⢠Peptic ulcer especially NSAIDS-associated
⢠Pathological hyper secretory condition e.g. :
Zollinger-Ellison
20. Side effects
ď§ diarrhea,
ď§ Nausea & vomiting
ď§ headaches
ď§ rash and dizziness
ď§ Nervousness
ď§ abnormal heartbeat
ď§ muscle pain, weakness and leg cramps
ď§ water retention :infrequently.
21. Drug â drug interaction:
ď§Increase blood concentration of:
ď§ Diazepam : decrease its hepatic elimination
ď§ Digoxin : increase its gastric absorption
ď§Decrease concentration of:
ď§ Ketoconazole : decrease its gastric absorption
22. Dosage:
ď§ For GERD:
20 or 40 mg of esomeprazole once daily for 4-8 weeks
ď§ For H. pylori:
40 mg once daily + amoxicillin and clarithromycin for 10
days.
ď§ The dose for preventing NSAID-induced ulcers :
20 to 40 mg daily for 6 months.
ď§ Zollinger-Ellison syndrome:
40 mg twice daily.