Hydrochloric acid, which is produced in the stomach, is essential for the digestive process. The mucus membrane lining the wall of the stomach protects the stomach cells from acid attack. However, in certain conditions, this protective lining is damaged or there is excessive production of acid in the stomach. In these cases, the acid in the stomach may corrode the cells and form an ulcer on the lining of the stomach. This is called as peptic ulcer.
Peptic ulcer symptoms and causes
Peptic ulcer disease is a common condition characterized by pain in abdomen, nausea and vomiting. If left untreated, it may even lead to upper gastrointestinal bleeding. In most of the cases, an infection caused by helicobacter pylori is the reason behind stomach ulcers. However, they may also be caused by excessive use of non-steroidal anti-inflammatory medicines, anxiety or consuming spicy food too often. Tumors like gastrinomas which lead to excessive acid production may also cause peptic ulcers.
Inhibiting the release of hydrochloric acid from the stomach lining forms the mainstay of the treatment for peptic ulcers. This provides time for the ulcers to heal. In case of helicobacter pylori infection, adequate antibiotics are also added for around two weeks to control the infection. In case of tumors, surgical resection can be considered.
Acid production is controlled with the help of histamine 2 blockers like ranitidine or with proton pump inhibitors like omeprazole. Although both these groups of medicines reduce the production of acid in stomach, their mechanism of action is very different.
Histamine 2 receptor antagonists like ranitidine
When histamine, a chemical present in the body binds with the histamine 2 receptors present on cells lining the stomach, acid is produced. H2 receptor antagonists like ranitidine compete with histamine to bind with the receptors and thus prevent acid production in the stomach.
Proton pump inhibitors like omeprazole
Production of acid in the stomach also requires the activation of the H+/K+ ATPase enzyme system present on the secretory surface of the gastric cells. This enzyme system is better known as the acid (proton) pump and is an important part of the acid production mechanism inside the stomach. Omeprazole acts by blocking this proton pump. Its action is dose related and the maximum action takes place within two hours of consuming the medicine. The anti-secretory effect of omeprazole lasts long because of prolonged binding to the H+/K+ ATPase enzyme. The drug is effective with once daily dosing and its inhibitory action can last for up to 72 hours.
Multiple studies done in the past have shown that omeprazole is significantly more effective than ranitidine in healing peptic ulcers and providing relief from the symptoms. Most of the physicians prefer prescribing omeprazole to patients suffering from peptic ulcer disease. Some physicians have tried a combination of ranitidine and omeprazole to treat stubborn gastro-esophageal reflux disease. However, the results obtained are not very different from the ones obtained while prescribing omeprazole alone. Therefore, keeping in mind the literature currently available, the combination therapy is not recommended over proton pump therapy alone for the treatment of peptic ulcer disease.
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