GERD胃食管反流英文版课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/9/14,#,Agents to Treat Gastric Acidity and Gastroesophageal Reflux Disease(GERD),Presented by,Abby Roth,Agents to Treat Gastric Acidit,Overview,Introduction,Symptoms,Causes,Peptic Ulcer Disease,H. pylori,NSAIDs,GERD,Treatments,OverviewIntroduction,Who is Affected?,Gastric acidity and GERD affects people of all ages, races, and gender,Who is Affected?Gastric acidit,Symptoms,Heartburn,Acid Indigestion,Regurgitation,Nausea,SymptomsHeartburnRegurgitation,Symptoms Continued,Hoarseness,Sore Throat,Chest Pain,Bad Breath,Dry Cough,Asthma*,Symptoms ContinuedHoarseness,Symptoms in Children,Vomiting,Coughing,Breathing Problems,Symptoms in ChildrenVomiting,Acid-Peptic Disorders,Peptic Ulcer Disease,Occurs when there is an imbalance between the mucosal defense factors and the acid and pepsin.,Acid-Peptic DisordersPeptic Ul,Helicobacter pylori Infection,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,Helicobacter pylori InfectionC,H. pylori,Produce large amounts of urease,Urease,H,2,0,3 NH,3,+ CO,2,Urea,H. pyloriProduce large amounts,H. pylori,Secret proteins and toxins that interact with the stomachs epithelial cells,Leads to inflammation and damage,H. pyloriSecret proteins and t,NSAIDs,Aspirin, Ibuprofen, Naproxen,Can have an affect at very low doses,Suppresses cylooxygenase-1,Decrease production of prostaglandins,NSAIDsAspirin, Ibuprofen, Napr,What is GERD?,Condition where the stomach acid/content is pushed back or “refluxed” into the esophagus,Affects 10 million Americans,Approximately 7% have daily symptoms,Link,What is GERD?Condition where t,GERD vs. NERD,Patients suffering symptoms are placed in two groups,Non-erosive reflux disease, or NERD,Erosive esophagitis,Erosive esophagitis is characterized by swelling and Inflammation,Barretts Esophagus,Precursor to Esophageal Cancer,GERD vs. NERDPatients sufferin,Causes of GERD,Abnormalities with the Lower Esophageal Sphincter, or LES,Stomach Abnormalities,Hiatal hernia,Link,Causes of GERDAbnormalities wi,Causes,Medications,NSAIDs,Calcium Channel Blockers (high blood pressure, angina),Causes Medications,Medications,Anticholinergics (urinary tract disorders),Beta Adrenergic Agonists (asthma),Dopamine (Parkinsons disease),MedicationsAnticholinergics (u,Causes,Food and Drinks,Carbonated beverages,Chocolate,Alcohol,Citrus Fruits,Coffee or Tea,Fatty foods,Containing tomatoes,Mint,Spicy Food,CausesFood and Drinks,Causes,Smoking,Damages mucus membranes,Impairs muscle reflexes in the throat,Increases acid secretion,Reduces LES function and salivation,CausesSmoking,Causes,Obesity,Laying down after a large meal,Eating close to bed time,Exercise,CausesObesity,Release of Gastric Acid,Release of Gastric Acid,Release of Gastric acid,Histamine stimulates acid release by interacting with the histamine receptor, H,2,Acetylcholine activates the cholinergic receptors,Gastrin is released when food is present in the stomach,Release of Gastric acidHistami,Treatments,Antacids,Alginates,Sucralfate,Proton Pump Inhibitors,Histamine H,2,-Recptor Antagonists,Prokinetics,New Treatments,TreatmentsAntacids,Antacids,Quick but short term,Buffer gastric acid, increasing the pH,Neutralize acid by the following reaction,Al(OH),3,+ 3 HCl AlCl,3,+ 3 H,2,O,AntacidsQuick but short term,Antacids,Maalox,Al(OH),3,(aluminum hydroxide), Mg(OH),2,(magnesium hydroxide),AntacidsMaalox,Antacids,Tums,CaCO,3,(calcium carbonate),AntacidsTums,Antacids,Pepto-Bismol,C,7,H,5,BiO,4,(bismuth subsalicylate),AntacidsPepto-Bismol,Antacids,Alka-Seltzer,NaHCO,3,(sodium bicarbonate),AntacidsAlka-Seltzer,Alginates,Alginates,Usually combined with an antacid,Forms protective barrier on top of gastric contents,Gaviscon,Sodium Alginate, Sodium Bicarbonate, and Calcium Carbonate,Link,AlginatesAlginates,Alginates,Polysaccharide found in the cell walls of brown algae,Sodium alginate is the sodium salt of alginic acid,AlginatesPolysaccharide found,Alginic Acid,Alginic Acid,Sucralfate,Reacts with stomach acid to from a cross linked viscous polymer that acts as an acid buffer,Can bind to proteins on the surface of an ulcer to prevent further acid damage,Has been shown to aid in healing by promoting epidermal growth factors and prostaglandins,SucralfateReacts with stomach,Sucralfate (Carafate),Sucralfate (Carafate),Proton Pump Inhibitors,Proton pump inhibitors (PPIs),Inhibits the gastric acid pump, H,+,/K,+,ATPase,Are prodrugs,Proton Pump InhibitorsProton p,PPIs,Diffuse into the parietal cells of the stomach and accumulates,Activated by proton-catalyzed formation of sulfenic acid,This prevents the drug from diffusing out,Activated form then irreversibly binds at the sulfhydryl groups of the cysteins of the H,+,/K,+,ATPase,Link,PPIs Diffuse into the parietal,Cysteine,Cysteine,GERD胃食管反流英文版课件,PPIs,Rabeprazol (Acipex),PPIsRabeprazol (Acipex),PPIs,Lansoprazole (Prevacid),PPIsLansoprazole (Prevacid),PPIs,Esomeprazole (Nexium),PPIsEsomeprazole (Nexium),PPIs,Omeprazole (Prilosec),Omeprazole/sodium bicarbonate (Zegerid),PPIsOmeprazole (Prilosec)Omepr,PPIs,Pantoprazole (Protonix),PPIs Pantoprazole (Protonix),Treatments,Histamine H,2,-recptor antagonists (H,2,RAs),The hormone, histamine stimulates the release of acid by interacting with the histamine receptor, or H,2,receptor.,Inhibit acid secretion by competitively and reversibly blocking parietal cell H,2,-receptors,Less potent then PPIs,TreatmentsHistamine H2-recptor,Agonist vs. Antagonist,An agonist is a drug that produces the same response at a receptor as the natural messenger,An antagonist is a drug which binds to a receptor without activating it, prevent an agonist or natural messenger from binding,Agonist vs. AntagonistAn agoni,Histamine,Histamine,GERD胃食管反流英文版课件,H,2,RAs,Cimetidine (Tagamet),H2RAsCimetidine (Tagamet),H,2,RAs,Nizatidine (Axid),H2RAsNizatidine (Axid),Other H,2,RAs,Ranitidine HCl (Zantac),Famotidine (Pepcid),Other H2RAsRanitidine HCl (Zan,Treatments,Prokinetics,Increase LES function,Release stomach contents by,Activating serotonin receptors,Acting on dopaminergic receptors,TreatmentsProkinetics,Prokinetics,Metoclopramide (Reglan, Degan),ProkineticsMetoclopramide (Reg,Prokinetics,Domperidone (Motilium, Costi),ProkineticsDomperidone (Motili,Prokinetics,Cisapride (Prepulsid, Propulsid),ProkineticsCisapride (Prepulsi,Prokinetics,Rarely used because of severe side effects,Fatigue,Tremors,Parkinsonism,Tardive Dyskinesia,Severe cardiac events,ProkineticsRarely used becaus,New Treatments,Cholecystokinin,2,receptor antagonists (CCK,2,),Potassium competitive acid blockers (P-CABs),New TreatmentsCholecystokinin2,Treatments,Cholecystokinin,2,receptor antagonists (CCK,2,),Block the CCK,2,receptors inhibiting acid secretion,Still in clinical trials,Best use in combination with PPIs,TreatmentsCholecystokinin2 rec,CCK,2,Itriglumide,CCK2Itriglumide,CCK,2,Z-360,CCK2Z-360,Treatments,Potassium competitive acid blockers (P-CABs),Target H,+,/K,+,ATPase,Ionically binds to the proton pump,Specific for the K,+,binding region and prevents acid secretion,Binds reversibly,Still in clinical trials,TreatmentsPotassium competitiv,P-CABs,Revaprazan,P-CABsRevaprazan,P-CABs,Soraprazan,P-CABsSoraprazan,Treatment for H. pylori,Amoxicillin + clarithromycin + proton pump inhibitor,Metronidazole + clarithromycin + proton pump inhibitor,Bismuth subsalicylate + metronidazole + tetracycline + proton pump inhibitor,Treatment for H. pyloriAmoxici,Assigned Reading,Vesper, J.B. et all,Gastroesophageal Reflux Diesease, Is there More to the Story?,ChemMedChem (2008),3, 552-559.,Assigned ReadingVesper, J.B. e,Homework Questions,What is an antagonist and how do the H,2,RAs (histamine receptor antagonists) act as one?,Explain the precise biological mechanism whereby prokinetics achieve their effect, including the receptors they act upon. Are they agonists or antagonists? Of which chemical messenger?,What is a prodrug? What causes the PPIs to become an active drug?,Bacteria in the upper GI tract may play a role in GERD. Explain.,Homework QuestionsWhat is an a,经常,不断地学习,你就什么都知道。你知道得越多,你就越有,力量,Study Constantly, And You Will Know Everything. The More You Know, The More Powerful You Will,Be,学习总结,经常不断地学习,你就什么都知道。你知道得越多,你就越有力量学,64,结束语,当,你尽了自己的最大努力,时,，,失败,也是伟大,的，所以不要放弃，坚持就是正确的。,When You Do Your Best, Failure Is Great, So DonT Give Up, Stick To The,End,演讲,人：,XXXXXX,时,间：,XX,年,XX,月,XX,日,结束语,65,