Drugs that reduce the acidity, are used in peptic ulcer, in gastroesophageal reflux disease (GERD, Gastroesophageal Reflux Disease) and in many forms of gastritis. Some drugs are part of the treatment regimen for H. pylori infection. Drugs include proton pump inhibitors H2 blockers antacids prostaglandins proton pump inhibitors These drugs are potent inhibitors of the enzyme H +, K + -ATPase. This enzyme, which is localized in the apical membrane of the parietal cell secretory, plays a key role in the release of H + (protons). The drugs inhibit the acid release completely and have an excellent long-term effect. They promote ulcer healing and are key components of H. pylori Eradikationsschemas. Proton pump inhibitors have replaced almost all clinical situations because they act faster and more effectively H2 blockers. To the proton pump inhibitors include esomeprazole, lansoprazole and pantoprazole, rabeprazole, esomeprazole, all for oral medication and i.v. are available therapy, omeprazole and rabeprazole are available only for the oral medication in the United States (p. Proton pump inhibitors). Omeprazole and lansoprazole are available without a prescription in the US. In uncomplicated duodenal omeprazole 20 mg p.o. once daily or lansoprazole 30 mg po given once daily for 4 weeks. Complicated duodenal ulcers (eg. As multiple ulcers, bleeding ulcers, those> 1.5 cm, or ulcers in patients with serious underlying medical conditions) respond better to higher doses of (omeprazole 40 mg once daily, lansoprazole 60 mg once daily or 30 mg two times daily). Gastric ulcers require a 6- to 8-week therapy, gastritis and GERD a 8- to 12-week therapy, a long-term maintenance therapy be performed in addition in a GERD needs. … Proton pump inhibitors medicament Usual dosage * complicated duodenal ulcer esomeprazole 40 mg of 1-times daily 40 mg 2 times daily 30 mg lansoprazole 1 time daily (Pediatric dose: <10 kg 7.5 mg 1 time daily 10-20 .; 15 mg kg-1 times a day .; ? 20 kg 30 mg 1 time daily) 30 mg 2 times daily omeprazole 20 mg of 1-times daily (pediatric dose... 1 divided into 2 doses daily.) 40 mg of 1-times daily. Pantoprazole 40 mg of 1-times daily. 40 mg 2 times daily mg / kg / day in a single dose or, rabeprazole 20 mg of 1-times daily. 20 mg of 2 times daily. * gastritis, gastroesophageal reflux disease, uncomplicated duodenal ulcers. Representative doses. The data is limited to the use of proton pump inhibitors in children. The long-term therapy with proton pump inhibitors leads to increased Gastrinspiegeln and hyperplasia of the enterochromaffinartigen cells. However, there is no evidence of dysplasia or malignant transformation in patients undergoing this therapy is used. Some of them may develop a vitamin B12 malabsorption. H 2 blockers These medications (cimetidine, ranitidine, famotidine, available i.v. or p.o., and nizatidine, only p.o. available) are competitive inhibitors of histamine at the H2-receptor, thereby suppressing the gastrinstimulierte acid release and reduce proportionally the gastric juice volume. The histamine-mediated release Pepsi is also reduced. Nizatidine, famotidine, cimetidine and ranitidine are available without a prescription in the US. H2 blockers are absorbed from the GIT and act already 30-60 min after ingestion with a maximum effect after 1-2 hours. For i.v. Handover occurs the effect of a rapid. The duration of the effect is dose proportional and varies from 6 to 20 h. In elderly patients, the dose should be reduced more frequently. In duodenal once daily oral administration of cimetidine 800 mg, ranitidine 300 mg, 40 mg famotidine or nizatidine 300 mg, about 6-8 weeks to night or after dinner is given effect. Stomach ulcers respond to the same treatment regimen that continues for 8-12 weeks, but because the nocturnal acid secretion plays a lesser role in this situation, the morning dose is just as effective or even more effective. Children ? 40 kg receive the adult dose. Below this weight, the oral dose of ranitidine is 2 mg / kg every 12 h and that of cimetidine 10 mg / kg every 12 h. In a GERD H2 blockers are now mainly used for pain management. Gastritis heals with famotidine or ranitidine, given two times a day for 8-12 weeks. Cimetidine has a low anti-androgenic activity, which manifests itself in a reversible gynecomastia and less frequent in long-term administration as erectile dysfunction. Changes in mental status, diarrhea, rash, drug-induced fever, myalgia, thrombocytopenia, sinus bradycardia and hypotension following rapid intravenous administration have been reported for all H2 blockers; affected are generally <1% of treated patients, elderly patients, however, are more commonly affected. Cimetidine and to a lesser extent, other H2 blockers interact with the microsomal enzyme system P450 and can thus the metabolism of other drugs that are eliminated in this system (e.g.., Phenytoin, warfarin, theophylline, diazepam, lidocaine), affect. These substances antacids neutralize stomach acid and reduce the activity of pepsin (which is reduced when the gastric pH to> 4.0 increases). In addition, some antacids absorb pepsin. Antacids can also interfere with the absorption of other drugs (eg., Tetracycline, digoxin, iron). Antacids lead to the alleviation of symptoms, promote ulcer healing and reduce the recurrence rate. They are relatively inexpensive, but they must be taken daily to 7 times 5. The optimal antacid regimen for ulcer healing seems in the administration of 15-30 ml of the solution or 2-4 tablets, 1 and 3 hours after each meal and at night given to insist. The total daily dose of antacids should have a neutralizing capacity of 200-400 mEq. However, antacids have been replaced by Säuresuppressionstherapie in the treatment of ulcer disease and are therefore generally used only for immediate relief. There are generally two types of antacids: absorbable and nonabsorbable. Absorbable antacids (eg., Sodium bicarbonate, calcium carbonate) ensure rapid complete neutralization but may cause alkalosis and should be applied only for a short time (1 or 2 days). Nonabsorbable antacids (for. Example, aluminum or magnesium hydroxide) have less systemic side effects and are therefore preferred. Aluminum hydroxide is a relatively safe, like-used antacid. Occasionally occurs with chronic use a reduction of phosphate on as a result of the binding of phosphate by aluminum in the GIT. takes (incl. dialysis patients) to the risk of Phophatverminderung in alcoholics, malnourished patients and those with kidney problems. Aluminum hydroxide causes constipation. Magnesium hydroxide is aluminum hydroxide as a more effective antacid, but can cause diarrhea. To limit such diarrhea can be combined in many Antazidapräparationen magnesium and Aluminiumantazida. Because small amounts are absorbed by magnesium, magnesium preparations should be used cautiously in patients with kidney disease. Certain prostaglandins, prostaglandins (particularly Misoprostol) inhibit acid secretion, by reducing the formation of cyclic AMP, which is triggered by the histamine stimulation of parietal cells, and strengthen the defense mechanisms of the mucous membrane. Synthetic Prostaglandinabkömmlinge v. a. used to reduce the risk of NSAID-induced mucosal injury. High-risk patients for NSAID-induced ulcers (eg. As elderly patients, patients with a history of ulcers and ulcer complications, patients taking corticosteroids at the same time) are candidates for taking misoprostol 200 micrograms p.o. 4 times a day with meals and their NSAID. Common side effects of misoprostol are abdominal cramps and diarrhea that occur in 30% of patients. Misoprostol can cause abortion and is therefore absolutely contraindicated in women of childbearing age and in those who adhere to no contraceptive measures. Sucralfate This medicine is a Sucrosealuminiumkomplex, the dissociated in the stomach and forms a physical barrier in the inflamed tissue, and thus shields this from acid, pepsin, and bile salts. It also inhibits the interaction of Pepsi substrates, stimulates mucous production of prostaglandins and binds bile salts. It has no effect on the release of acid appears to have a trophic effect on the ulcerated mucosa, possibly by the binding and concentration of growth factors in the ulcer. Systemic absorption of sucralfate may be neglected. In 3-5% of patients it comes to constipation. Sucralfate may bind to other drugs and interfere with their absorption.