Omeneu Instant(Omeprazole

+Sodiumbicarbonate)

Digestive System• Esophagus( tube that connects your

mouth and your stomach)• Stomach• Small Intestine• Large Intestine• Gall bladder• Liver• Pancreas

Stomach• A stretchy bag that holds

your food after you eat.Stomach has 4 major roles in human body.

• To store food• To mix the food with HCl and pepsin• To reduce the size of food particles• To empty the partially digested food

into the small intestine

Esophagus

Stomach

Stomach Cells• Parietal cells (oxyntic cells) are the stomach epithelium cells

which secrete gastric acid.

• Parietal cells produce gastric acid (hydrochloric acid) in response to histamine (via H2 receptors), acetylcholine (M3 receptors) and gastrin (gastrin receptors).

• Parietal cells contain an extensive secretary network (canaliculi) from which the HCl is secreted by active transport into the stomach.

Acid-Related Pathophysiology

The stomach secretes:• Hydrochloric acid (HCl)• Bicarbonates• Pepsinogen• Mucus• Prostaglandins

Gastroesophageal Reflux Disease (GERD

• Most common disorder of esophagus• Characterized by regurgitation of gastric contents into

esophagus and exposure of esophageal mucous to gastric acid and pepsin.

• Main symptom is heart burn – occurs after eating.

Complications of GERD

• Esophagitis, stricture or ulcer• Barrett’s Esophagus

Peptic Ulcer

• Condition characterized by Erosion of GI mucosa resulting from digestiveaction of HCl and pepsin

• Ulcer development– Lower esophagus– Stomach– Duodenum

Gastric Ulcer

• common in late middle age– incidence increases with age

• Use of NSAIDs - associated with a three- to four-fold increase in risk of gastric ulcer

• Less related to H. pylori than duodenal ulcers – about 80%

• 10 - 20% of patients with a gastric ulcer have a concomitant duodenal ulcer.

Duodenal Ulcer• Duodenal sites are common as

gastric sites • Most common in middle age • Male to female ratio—4:1 • Associated with increased serum

pepsinogen• H. pylori infection common up to

95%• Smoking is twice as common

Helicobacter Pylori (H. pylori)

• Helicobacter Pylori (H. pylori) is a spiral shaped bacterium found in the stomach.

• H. pylori damages stomach and duodenal tissue

• Causes 80% of peptic ulcers• Survives the acid environment by

attaching to the sugar molecules that line the stomach wall

• Uses the mucus layer as protection

Zollinger-Ellison Syndrome

• Zollinger-Ellison Syndrome is a rare disorder that causes one or more tumors to form in the pancreas or

• upper part of the small intestine called the duodenum. • The tumorsare called gastrinomas, and they secrete a large amountof the hormone gastrin. • In this syndrome increased levels of the hormone

gastrin are produced, causing the stomach to produce excess

 

Release of Gastric Acid• Histamine stimulates acid release by

interacting with the histamine receptor• Acetylcholine activates the cholinergic

receptors• Gastrin is released when

food is present in the stomach

Proton Pump Inhibitor

Mode of ActionProton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell.

Blocks the enzyme in the wall of the stomach that produces acid.

Antacids

• Quick but short term• Buffer gastric acid, increasing the pH• Neutralize acid by the following reaction

NaHCO3 + HCl NaCl + H2O + CO2

Dosage ScheduleIndication Dose Frequency

Short-Term Treatment of Active Duodenal

Ulcer

20mg Once daily for 4 weeks

Benign Gastric Ulcer 40mg Once daily for 4-8 weeks

Gastroesophageal Reflux Disease (GERD)

Symptomatic GERD (with no esophageal

erosions)

20mg Once daily for up to 4 weeks

Erosive Esophagitis 20mg Once daily for 4-8 weeks

Maintenance of Healing of Erosive

Esophagitis

20mg Once daily