Farmakoterapi Tukak Lambung (Dispepsia)

Summary

This script covers the topic of gastric ulcers (tukak lambung), explaining the distinction between functional and organic dyspepsia. It highlights how dyspepsia is diagnosed, the causes of gastric ulcers such as H. pylori infection and NSAID use, and the factors affecting the stomach’s defense and aggression balance. The treatment options include empiric therapy using antacids, H2-receptor antagonists, and proton pump inhibitors (PPIs). The script further details the diagnostic methods like endoscopy and urea breath tests, as well as specific treatment regimens for H. pylori infection and NSAID-induced ulcers, with considerations for proper medication choices and durations.

Takeaways

• 😀 Dispepsia is a symptom, not a disease, representing discomfort in the upper abdomen.
• 😀 Dispepsia is categorized into two types: functional and organic. The difference lies in whether there is physical damage in the stomach or intestines.
• 😀 Functional dyspepsia shows no physical damage, whereas organic dyspepsia includes conditions like gastritis, peptic ulcers, and esophagitis.
• 😀 A person is diagnosed with dyspepsia if symptoms persist for 3-6 months.
• 😀 Empiric therapy is used to treat undiagnosed dyspepsia, often involving antacids, H2RA, or PPIs.
• 😀 Peptic ulcers (tukak lambung) occur due to an imbalance between defensive factors (mucus, prostaglandins, bicarbonates) and aggressive factors (gastric acid, pepsin).
• 😀 The main causes of peptic ulcers are H. pylori infection and long-term NSAID use.
• 😀 H. pylori is a Gram-negative bacterium that damages the mucus layer, leading to ulcers. It also produces urease, which can be detected via the Urea Breath Test.
• 😀 NSAIDs cause ulcers by irritating the stomach lining and inhibiting the production of prostaglandins that protect the mucus layer.
• 😀 Diagnosis of peptic ulcers is commonly done through endoscopy or the Urea Breath Test to confirm H. pylori infection.
• 😀 Treatment of peptic ulcers involves antibiotics (for H. pylori), PPIs, H2RAs, and sometimes stopping or switching NSAIDs for pain relief.

Q & A

What is dyspepsia, and how is it categorized?

Dyspepsia is a symptom characterized by discomfort in the upper abdomen. It is not a disease itself. Dyspepsia is categorized into two types: functional dyspepsia (no damage to the stomach or intestines) and organic dyspepsia (which involves damage such as inflammation, gastritis, ulcers in the stomach, or intestines).

How is functional dyspepsia diagnosed?

Functional dyspepsia is diagnosed when the symptoms, such as upper abdominal discomfort, persist for 3 to 6 months. If no organic damage is found through examination, it is classified as functional dyspepsia.

What is the difference between functional and organic dyspepsia?

Functional dyspepsia does not involve any physical damage to the stomach or intestines, while organic dyspepsia is associated with physical damage such as inflammation (gastritis) or ulcers in the stomach, duodenum, or esophagus.

What are the defensive and aggressive factors in the stomach?

Defensive factors include mucus, bicarbonate ions, and prostaglandins, which protect the stomach lining from acidic damage. Aggressive factors include hydrochloric acid (HCl) and pepsin, which are essential for digestion but can damage the stomach lining if unbalanced.

What role does mucus play in the stomach?

Mucus serves as a protective layer on the stomach lining, preventing the stomach from being damaged by its own highly acidic environment (HCl). It acts as a barrier to safeguard the underlying mucosa from the harmful effects of stomach acid.

How does Helicobacter pylori contribute to peptic ulcers?

Helicobacter pylori is a gram-negative bacterium that secretes protease, which can destroy the protective mucus layer in the stomach. This leads to damage of the stomach lining, increasing the risk of peptic ulcers. It also produces urease, which converts urea into ammonia, contributing to the ulcer formation.

What is the main cause of peptic ulcers related to medication?

The long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can contribute to peptic ulcers. These drugs irritate the stomach lining and inhibit the production of prostaglandins, which normally help protect the stomach by promoting mucus production.

What are the common symptoms of bleeding caused by peptic ulcers?

Bleeding from peptic ulcers can lead to hematemesis (vomiting blood) and melena (black, tarry stools). These are signs that blood is being lost from the upper digestive tract, often due to an ulcer eroding into blood vessels.

What is perforation in the context of peptic ulcers, and why is it dangerous?

Perforation occurs when a peptic ulcer creates a hole in the stomach or duodenal wall, allowing contents from the non-sterile digestive tract to enter the sterile peritoneal cavity. This can lead to peritonitis, a life-threatening condition requiring immediate surgical intervention.

How is Helicobacter pylori infection diagnosed?

Helicobacter pylori infection can be diagnosed through an urea breath test (UBT) or endoscopy. The urea breath test involves giving the patient a substance that contains urea labeled with carbon-14, which is broken down by H. pylori, releasing carbon dioxide that can be detected in the breath.

What is the first-line treatment for Helicobacter pylori infection?

The first-line treatment for H. pylori infection involves a combination of a proton pump inhibitor (PPI) like omeprazole, amoxicillin, and clarithromycin, typically administered for 7-14 days to eradicate the bacteria.

What is the role of PPIs, H2 blockers, and antacids in the treatment of peptic ulcers?

PPIs (Proton Pump Inhibitors) inhibit the proton pump that produces stomach acid, making them the most potent treatment for ulcers. H2 blockers reduce acid production by blocking histamine receptors on parietal cells. Antacids neutralize stomach acid, raising the pH of the stomach to alleviate symptoms.