The major agents in the current armamentarium against peptic ulcer disease are: • H2-receptor antagonists • H+,K+-ATPase (acid pump) inhibitors • Sucralfate • Antacids • Bismuth compounds.
Muscarinic cholinergic antagonists can reduce basal secretion of gastric acid, selective M1 antagonists are as effective as atropine or other non selective muscarinic antagonists , but they are less likely to produce the adverse effects that are occurred usually by cholinergic blockage(dry mouth, tachycardia ).
Muscarinic blocking drugs used for ulcer because they reduce peristaltic movement of G.I.T particularly the intestine and this is why mainly used for duodenal ulcer.
IV- Sucralfate
is a complex substance formed from a sulfated disaccharide and polyaluminum hydroxide .It polymerizes when the pH below 4.
The condensed polymer forms a gel, which adhere to the base of duodenal ulcer.
When sucralfate taken before meals, it is effective for the treatment of duodenal ulcer disease.
Sucralfate works by creating a protective coating over the ulcer to protect it from acid and digestive juices, thus allowing it to heal. It also helps to strengthen the defenses of the stomach lining. Sucralfate may be more effective than H2 blockers in patients who smoke.
Adverse reactions are minimal because not systematically absorbed.
V- Prostaglandine E2 analogue
is used as anti ulcer by inhibiting acid secretion and increase mucous release e.g misoprostil.