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 DEFINITION
- They constitute the first group the Omeprazol, and the Lansoprazol. Both produce the Inhibition of the "Bomb of protons", which constitutes the principal element of the mechanism secretor of acid in the stomach. This inhibition is irreversible and, therefore, the therapeutic effect lasts much more than it might be expected from the short presence in the body of these medicines.
- The healing indexes are similar to those of the antihistamines H2 in gastric ulcer, but they are slightly better in ulcer duodenal and significantly better in esofagitis for ebb.
As other groups of medicines that are used in the ulcers (anti H2) are very effective, his principal characteristic that differentiates them is that the healing period is short producing to the time the mitigation of the symptomatology and the healing process. The importance side effects do not overcome 1 % of the cases.
- The antihistamines H2 (Cimetidina, Ranitidina, Famotidina, Nizatidina) produce the inhibition of the acidic secretion for blockade of the specific recipients of production of acid (H2 of the histamine). They do not present significant differences between they. They can be used in one or two daily captures with similar efficacy. The most modern have less adverse effects than the cimetidina, since they do not alter the metabolism of the liver, being this preferable in elders and when other medicines are used simultaneously (antiallergic, teofilina, etc.), but there are slightly significant advantages if we bear in mind that the adverse effects do not overcome 3 % of the cases.
- The protectors of the mucous membrane (sucralfato) act forming like a patch that settles in the ulcer and this prevents the attack of the acids of the stomach in the damaged area These medicines are not absorbed.
- The prostaglandin (Misoprostol) increases the resistance of the wall of the stomach to the acids and to high doses they block the acids secretion. Of efficacy similar to other groups of antiulcer but of more side effects, since diarrhea usually appears in 10 % of the cases. It is not possible to use in the pregnancy. If they seem to be more effective in the prevention of ulcers produced by the anti-inflammatory ones.
- In addition to producing a protective lid of the mucous membrane, the Dicitrato bismutato tripotásico can have an inhibiting effect of the bacterium Helicobacter pilori, which is created it is related to the etiology of the ulcer. Another protector is the Acexamato of zinc, which seems to stabilize also the mastocitos and inhibit the histamine secretion.
- The Pirenzepina produces a nervous blockade (colinérgico) of the secretion of acids, for it also it produces dryness of mouth (3,9 %) and blurry vision (1,7 %).
- For the treatment of the ulcer a treatment is realized normally in sharp period of 1 or 2 months. Since, on having suspended them, there is a high percentage of relapsing, it usually do a maintenance treatment to half of dose (in the night) during long periods of time. This way the relapses are 8,5 % to 2,5 %. monthly, slightly major in the gastric ulcer than in the duodenal.
The treatment with antacids, sucralfato or pirenzepina there is similar to that of antagonists H2 in efficacy, being the only exception the dicitrato bismutato tripotásico with indexes of minor relapsing of 25 % at the age of 12 months, which seems to be as regards his performance against the Helicobacter pylori.
The efficacy of the omeprazol and of the misoprostol they are similar to the anti H2. For it the relapsing talks each other well doing a maintenance or realizing occasional shock rules; being sometimes necessary to alternate medicines.
THERAPY OF ERADICATION OF THE HELICOBACTER PYLORI
It seems that this bacterium is fundamental in the ulcerous illness, for it the treatments directed to try to eradicate this bacterium of the wall of the stomach are very effective to avoid the relapses.
It usually realize like more cash an association of:
- Omeprazol (20 mg 1vez a day) + amoxicilina (500 mg 4 times a day) + claritromicina (500 mg 3 times a day).
- Dicitrato bismutato tripotásico (120 mg 4 times a day) + metronidazol (250 mg 3 times a day) + tetraciclina (500 mg 4 times a day).
- Dicitrato bismutato tripotásico (120 mg 4 times a day) + metronidazol (250 mg 3 times a day) + amoxicilina (500 mg 4 times a day).
TO SEE ALSO
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DEFINITION 
