Danylo Halytsky Lviv National Medical University
Introduction. Antisecretory drugs are commonly used in the complex treatment of most diseases of the upper gastrointestinal tract. Today, proton pomp inhibitors (PPI) have a priority in the basic treatment for acid-dependent diseases of the gastrointestinal tract due to its higher acid-blocking ability. However, PPI have a number of disadvantages, including resistance, nocturnal acid breakthrough, hyperplastic processes stimulation, mucosa atrophic changes and dysbiosis. To eliminate these undesirable effects H2-histamine receptor blockers which don’t interfere in intracellular metabolism are recommended. Moreover, it was shown that H2-histamine receptor blockers have a reciprocal effect on the production of mucosal defense factors, namely enhancing the synthesis of mucoid component and bicarbonate in gastric juice. The most commonly used in clinical practice are blockers of the second and third generation. The impact of the H2-histamine blockers (second and third generation) on acid-peptic and mucoid-bicarbonate secretion in patients with acid-dependent lesions of the gastrointestinal tract has not been sufficiently studied, but comparative estimation of their impact on the gastric protective factors in both media (gastric juice and insoluble mucus) have not been studied before
The aim of the study. To investigate the peculiarities of the impact of H2-histamine receptors blockers (second and third generation) on gastric acid-peptic and mucoid-electrolyte secretion in patients with duodenal ulcer after single intragastric administration of nizatidine and famotidin.
Materials and methods. It involved 51 randomized patients with endoscopically confirmed diagnosis of duodenal ulcer in the exacerbation phase were investigated: nizatidine administered in 26 patients (f/m – 5/21) aged 18-68 years and famotidine – in 25 patients (f/m – 7/18) in age 21-70 years. All patients had a positive urease test for Helicobacter pylori. Fractional gastric tubing with submaximal histamine stimulation with further intragastral administration of H2-histamine blocker was performed. Hydrochloric acid and pepsin in the gastric juice and N-acetylneuraminic acid and Na+ ions in the gastric juice and insoluble mucus were analyzed in three portions: basal, after histamine stimulation and after nizatidine or famotidine administration. Finally, comparison between impacts of these preparations on the acid-peptic and mucoid-electrolyte secretion of the stomach was carried out
Results of the study. Intragastric administration of 150.0 mg nizatidine after submaximal histamine stimulation decreased total acidity by 33.1 % and pepsin secretion decreased by 23.9 %, meanwhile it increased N acetylneuraminic acid content in gastric juice and insoluble mucus by 24.5 % and 21.2 % respectively. Analogous changes are also revealed in the dynamics of Na+ release, which directly correlates with the secretion of gastric mucosa of hydrocarbonate compounds. The production of this ion both in gastric juice and insoluble mucus increased by 6.7 % and 12.0 % respectively.
Intragastric administration of 40.0 mg famodine after submaximal histamine stimulation decreased total acidity by 45.0 % and pepsin secretion decreased by 28.4 %, meanwhile it increased N-acetylneuraminic acid content in gastric juice and insoluble mucus by 24.6 % and 33.6 % respectively. Analogous changes are also revealed in the dynamics of Na+ release, which directly correlates with the secretion of gastric mucosa of hydrocarbonate compounds. The production of this ion both in gastric juice and insoluble mucus increased by 5.1 % and 15.5 % respectively.
The comparative characteristic of H2–histamine receptor blockers impact on acid-peptic function shows higher efficiency of third-generation (famotidine) drug against second-generation drug (nizatidine) in acid-peptic secretion blocking, their influence on production of N-acetylneuraminic acids as a marker of mucoid secretion and sodium ions as an indicator of hydrocarbon secretion did not differ significantly.
Conclusions. Famotidine more effectively blocked acid and peptic secretion compared to nizatidine, but their stimulating impact on mucoid-electrolyte secretion was not significantly different.
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