Pharmacology of antacids

Antacids are usually alkaline substances that are used to neutralise excess acid in the stomach. Antacids were developed based on the hydroxides and carbonates of the group II and III metals, as well as the bicarbonates of the alkali metals. Antacids can be classified into two main classes being non-absorbable or absorbable antacids. Non-absorbable antacids have fewer side effects and further advantageous properties. Each antacid has a specific active ingredient which has a different effect on the gastric acid. Antacids act similar to when an acid reacts with a hydroxide; a salt and water are produced. Antacids are more effective in the form of suspension. The average therapeutic dose of an antacid is 10–15 ml of liquid or one to two tablets three to four times a day. These drugs have small volumes of distribution, undergo minimal hepatic metabolism and are excreted in faeces. Antacids that contain calcium, magnesium and aluminium ions are chelators. To avoid undesirable interactions, antacids are usually used two hours before or after taking any medication. Stress ulcerations are common in intensive care unit (ICU) patients. The pathophysiology of the ulceration probably results from an imbalance between mucosal protection and gastric acid hypersecretion. Whilst prophylaxis was provided to every patient previously, it is wise to individualise the decision and to only provide it to high risk patients. For critically ill patients who are able to receive enteral medications and in whom prophylaxis is indicated, an oral proton pump inhibitor (PPI) is preferred rather than an alternative prophylactic agent. For critically ill patients who cannot receive enteral medications, an intravenous (IV) histamine 2 (H2) receptor blocker or IV PPI can be administered. Where PPIs or H2 blockers cannot be administered, sucralfate is a suitable oral alternative.

Healing and Antisecretory Effects of Aqueous Extract of Eremomastax speciosa (Acanthaceae) on Unhealed Gastric Ulcers

Objective. This work investigated the healing and antisecretory effects of the aqueous extract of Eremomastax speciosa on “unhealed gastric ulcers” associated with gastric acid hypersecretion. Materials and Methods. “Unhealed gastric ulcers” were induced using indomethacin following the establishment of acetic-acid-induced chronic gastric ulcers. The extract (200 and 400 mg/kg, per os) was administered concomitantly with indomethacin (1 mg/kg, subcutaneously). The effects of the extract on both basal and histamine-stimulated gastric acid secretion were determined. Mucus secretion and oxidative stress parameters were measured, and histological assessment of ulcer healing was carried out. Results. The extract significantly promoted the healing process in rats subjected to “unhealed gastric ulcers” (82.4–88.5% healing rates). Treatment with the extract significantly reduced the basal (25.95–49.51% reduction rates) and histamine-stimulated (24.25–47.41%) acid secretions. The healing effect of the extract was associated with a significant (p<0.05) increase of mucus secretion and concentrations of antioxidant enzymes compared with the controls. The extract at the highest dose showed normalization of the mucosa, without glandular destruction and with the disappearance of fibrosis and lymphocyte infiltration. Conclusion. The abilities of the extract to increase mucus secretion, to reinforce antioxidant status, and to inhibit acid secretion would be some of the mechanisms by which this extract would accelerate the healing process in “unhealed gastric ulcers.”

Hubungan Derajat Keasaman Cairan Lambung dengan Derajat Dispepsia pada Pasien Dispepsia Fungsional

AbstrakHipersekresi asam lambung dianggap penting sebagai salah satu mekanisme patologis dispepsia fungsional. Hipersekresi asam lambung dapat meningkatkan sekresi pepsin yang dapat menimbulkan kerusakan mukosa lambung pada dispepsia fungsional. Tujuan penelitian ini adalah menentukan hubungan derajat keasaman cairan lambung dengan derajat dispepsia yang dialami pasien dispepsia fungsional. Penelitian ini merupakan studi analitik dengan disain cross sectional yang dilakukan pada 35 sampel pasien dispepsia fungsional dengan teknik consecutive sampling di RSUP DR. M.Djamil Padang mulai Juli sampai Oktober 2014. Analisis data dilakukan secara komputerisasi menggunakan uji chi-square. Hasil penelitian didapatkan 51.4% pasien dispepsia fungsional memiliki derajat keasaman cairan lambung hyperacidity, 57.1% menderita dispepsia derajat sedang-berat, dan menunjukkan hubungan yang cukup kuat dengan tarif signifikansi (p) 0.029 (p < 0.05). Terdapat hubungan bermakna antara derajat keasaman cairan lambung dengan derajat dispepsia pada pasien dispepsia fungsional. Peningkatan derajat keasaman cairan lambung berbanding lurus dengan derajat dispepsia pada pasien dispepsia fungsional.Kata kunci: keasaman cairan lambung, derajat dispepsia, dispepsia fungsional AbstractGastric acid hypersecretion is considered important as one of the pathological mechanisms of functional dyspepsia. Gastric acid hypersecretion can increase the secretion of pepsin which can cause gastric mucosal damage in functional dyspepsia. The objective of this study was to determine the correlation of gastric juice acidity with dyspepsia level experienced by functional dyspepsia patients.This study was a analytic study with cross sectional design applied on 35 samples of functional dyspepsia patients with non-probability consecutive sampling technique at RSUP DR. M. Djamil Padang from July to October 2014. The data were computerized analyzed using chi-square test. The results showed 51.4% of patients with functional dyspepsia had hyperacidity gastric juice, 57.1% had moderate-to-severe dyspepsia level, and show a strong enough correlation with the rate of significance 0.029 (p < 0.05).There was a significant correlation between the gastric juice acidity with dyspepsia level of functional dyspepsia patients. Increase of gastric juice acidity is proportional to the dyspepsia level in functional dyspepsia patients.Keywords::gastric juice acidity, dyspepsia level, functional dyspepsia