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Gastrointestinal System

Acid Balance of the Stomach
The digestive system is responsible from digestion of food intake, supplying needed substances to the blood and removing useless  substances from the body.
Main diseases caused by disturbance of the acid balance of the stomach, which takes place in the gastrointestinal tract in the digestive system are peptic ulcer, gastroesophageal reflux, dyspepsia, gastritis. Although the origin of the problem may be mechanical gastric diseases cause by a bacterium called Helicobacter pylori may develop.

Helicobacter pylori is a bacterium which grows and lives under the protective secretion layer of the stomach. H. Pylori both protects itself from the gastric acid and damages the inner layer of the stomach by secreting substances. Therefore it causes diseases such as dyspepsia, gastritis and ulcer. The rate of the infection increases with crowded life, bad hygienic situation and low social-economical situations. Transmission routes of the pathogen are not known exactly, however is it thought that the contaminated (dirty, infected with the bacteria) water has the responsibility. Other possible transmission routes are saliva, gastric secretions, contaminated food and feces. H. Pylori infections are commonly seen worldwide. The prevalence in adults in Turkey is similar to the other developing countries (80-85%). In order to ensure protection from the diseases affecting the digestive system, which are caused by this commonly seen bacterium, H. Pylori has to be destroyed. Therefore, multiple antibiotic treatment is used.

a) Peptic ulcer: Peptic ulcer forms with damages on the stomach and duodenum caused by the acid secreted from the stomach. It is usually on the bulbus, where the stomach and duodenum meet. There is a relation between this duodenum ulcer and the H. Pylori, which lives only in the stomach. This bacteria helps formation of ulcer, and treatment with antibiotics prevents the recurrence of the disease in the next years. If the bacteria is not destroyed, peptic ulcer will recur. Peptic ulcer can be cured by administering acid inhibiting drugs and by destroying H. Pylori totally from the stomach. To destroy H. Pylori, usually an acid inhibiting drug together with an antibiotic is administered. 

b) Reflux: Reflux is the returning of the acidic stomach content to the esophagus. Reflux is formed when a burning feeling at the back of the bone above the esophagus (sternum) and acidic, bitter and sour fluid reaching to the throat and mouth occur frequently for long periods. H2 receptor antagonists or proton pump inhibitors can be used to treat this disease.

c) Dyspepsia: It is also called indigestion and has symptoms like discomfort and pain in the upper abdomen, discomforting feeling of fullness, passing gas, belching, food and acid reaching the mouth. Some people can help to avoid dyspepsia by identifying and avoiding foods that disagree with them, by not eating too quickly and by avoiding stress Some people may need antacids or acid inhibiting drugs.

d) Gastritis: It is a kind of inflammation of the stomach mucosa. It means that the white blood cells accumulate on the mucosa after stimulation by various factors. Gastritis can be acute or chronic. Symptoms such as pain in the upper abdomen, passing gas, belching, burning, sour feeling, nausea and vomiting are seen in acute gastritis, whereas in chronic gastritis pain is less severe and dyspeptic complaints such as bloating and fullness after meals, early satiety, nausea, belching, lack of appetite and a bad taste in the mouth can be seen. Causes include: H. Pylori, Aspirin and anti-rheumatismal drugs, alcohol.

Major Drug Groups Used in the Treatment:
 
Proton pump inhibitors (or PPIs): Drugs that inhibit the production of the gastric acid for a long period. Today they are the most potential stomach acid inhibitors. PPIs work by irreversibly blocking the hydrogen/potassium ATPase enzyme system in the stomach parietal cell. Proton pump is the last stage in the acid secretion and is an ideal process for inhibition because its H+ secretion to the gastric lumen. In this manner, acid secretion is inhibited by 99%.
 
H2 antagonists: These are molecules, which decrease the acid secretion by blocking the effect of histamine in the stomach parietal cell. These drugs are used in dyspepsia treatment. They are also used in severe ulcer cases as maintenance treatment. H2 antagonists are the main drugs in the maintenance treatment.

Antibiotics: They are often combined with a PPI in the treatment to destroy H. Pylori bacterium.

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