ATC Group: A02BX Other drugs for peptic ulcer and gastro-oesophageal reflux disease (GORD)

Alginic acid is a polysaccharide distributed widely in the cell walls of brown algae which is hydrophilic and forms a viscous gum when hydrated. Its salts with metals such as sodium and calcium are known as alginates. It is a significant component of the biofilms produced by the bacterium Pseudomonas aeruginosa, a major pathogen found in the lungs of some people who have cystic fibrosis. The biofilm and P. aeruginosa have a high resistance to antibiotics and are susceptible to inhibition by macrophages.

Under the effect of gastric acid, a precipitate is formed from tripotassium dicitrato bismuthate, which adheres primarily to the ulcerated area and inhibits the activity of pepsin. Tripotassium dicitrato bismuthate contributes to the healing of a high percentage of gastric and duodenal ulcers.

Carbenoxolone is a glycyrrhetinic acid derivative with a steroid-like structure, similar to substances found in the flavor-ful root of the licorice plant. It influences endogenous glucocorticoids by potently inhibiting 11β-hydroxysteroid dehydrogenase. Electrolyte imbalance is a serious side effect of carbenoxolone when used systemically. Carbenoxolone is best known in cellular physiology as a modestly potent, reasonably effective, water-soluble blocker of gap junctions. It exerts anti-inflammatory activity. Carbenoxolone has used orally in the clinical treatment of peptic ulcers, now it is used topically for the treatment of lip sores and mouth ulcers.

Rebamipide, a gastroprotective drug, is a compound selected from over 500 amino acid analogs of 2(1H)-quinolinone. Rebamipide stimulates prostaglandin generation in gastric mucosa and improves not only the speed but also the quality of ulcer healing. Rebamipide works by enhancing mucosal defense, scavenging free radicals and temporarily activating genes encoding cyclooxygenase-2.

Sucralfate forms an ulcer adherent complex with the proteinaceous exudate of the ulcer site. This property enables sucralfate to form a protective barrier over the ulcer lesion giving sustained protection against the penetration and action of gastric acid, pepsin and bile.

Tripoxide is a gastric cytoprotective agent used for the treatment of gastritis and gastric uclers. Troxipide has a mode of action different from that for other anti-gastric agents: it does not inhibit acid secretion and does not have acid neutralizing activity. It exerts its activity by increasing mucus production, cytoprotective prostaglandin secretion, regeneration of collagen fibers, reducing inflammatory mediator induced neutrophil migration and reactive oxygen species generation in gastric mucosa, enhancing gastric mucosal metabolism and microcirculation.