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
esomeprazole is the s-enantiomar of omeprazole (racemic
mixture)
less first pass metabolism -> higher bioavailability -> more
effective and longer lasting acid blockage -> 24 h interval
Esomeprazole has increased antimicrobial activity
against Helicobacter pylori than omeprazole.
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
diarrhea,
Nausea & vomiting
headaches
rash and dizziness
Nervousness
abnormal heartbeat
muscle pain, weakness and leg cramps
water retention :infrequently.
21. Drug – drug interaction:
Increase blood concentration of:
Diazepam : decrease its hepatic elimination
Digoxin : increase its gastric absorption
Decrease concentration of:
Ketoconazole : decrease its gastric absorption
22. Dosage:
For GERD:
20 or 40 mg of esomeprazole once daily for 4-8 weeks
For H. pylori:
40 mg once daily + amoxicillin and clarithromycin for 10
days.
The dose for preventing NSAID-induced ulcers :
20 to 40 mg daily for 6 months.
Zollinger-Ellison syndrome:
40 mg twice daily.