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Tuesday, August 29, 2006
Dumaguing: Mucosta helps in preventing and healing ulcers
By Dr. Vic Dumaguing
To Your Health
HOW time changes things! Back in the 1970s, in med school, we were taught the very simplistic and admittedly logical cause and effect relationships of the pathogenic of peptic ulcer: no acid, no ulcer.
That explains why, the drug armamentarium of anti-ulcer drugs given to patients, are all directed against the hydrochloric acid (similar to the muriatic acid some of us use in cleaning our toilets) being produced by the parietal cells of the stomach. Therefore, antacids were the mainstay of ulcer therapy, followed by the histamine 2 receptor antagonist and lately, the so-called PPI or the proton-pump inhibitors; all of which directly or indirectly suppress acid secretion.
On hindsight, it may have been naïve on the part of the physicians, myself included, to ignore one very important factor in peptic ulcer disease. We have been so concerned about the aggressive agents that cause ulcers that we have overlooked strengthening the defensive factors that can significantly prevent ulcers in the first place.
That's why, the presence of Dr. Jose Sollano Jr. last August 15 at a round table discussion at the Baguio Country Club, brought a new perspective into the comprehensive management of peptic ulcer disease. Dr. Sollano, both a fellow of the Philippine College of Physicians and Philippine Society of Gastroenterologist, is a highly esteemed clinician and professor of the University of Santo Tomas, where he finished his medical course. In a series of interesting, colorful and well-prepared slides, he presented to medical practitioners of Baguio and Benguet, the intricate balance between the corrosive effects of hydrochloric acid-pepsin against the defensive mucosal barrier or lining of our gastrointestinal tract, particularly the stomach and the duodenum, areas most perfected by ulcers. While he acknowledge the vital roles of medications directed against the acid, Dr. Sollano also emphasized the importance of giving drugs that would enhance the barrier and cited the added benefits of such a drug in the over-all healing process.
Rebamipide (Mucosta) is a gastro-protective agent, effective in the treatment of acute and chronic gastritis and peptic ulcer especially gastric or stomach ulcer. Dr. Sollano pointed out that unlike before, there are now more cases of stomach ulcers rather than duodenal ulcers. The mechanisms of gastro-protective and anti-inflammatory actions of Mucosta are not completely understood but may be partly due to the various properties of the drug such as scavenging of cytokine-induced destructive substance, induction of synthesis or formation of good and "mucosa-friendly prostaglandin," inhibition of the secretion and release of pro-inflammatory cytokines by immune cells and quite possibly also, its ability to sequester or modulate the effects of responding neutrophils to the site of the mucosal injury.
The positive effect of Mucosta on the epithelial barrier of the stomach has been shown in vitro (lab situations) and in vivo (within the human body itself). It increases the integrity of the normal epithelium as proven by the increased electrical resistance of the epithelium. Moreover, Mucosta prevented the disruption of the mucosal barrier by Interleukin 1 and also pastially normalized and restored the intact protein membrane effected by Interleukin 1 and the infectious effects of the microbe Helicobacter pylori.
The protective effect of Mucosta on the epithelial, gastric and intestinal barrier function, its capacity to decrease the macrombacular absorption across the mucosal wall, leading to a decrease of the antigenic (non-self, foreign characteristics) load of the mucosa as well as its ability to down regulate the mucosal immune response to dietary antigens, may contributed to its overall gastro-protective and anti-inflammatory properties.
In the more than 10,000 patients treated, side effects were slight reductions in leukocytes and the thrombocytes, also an increase in liver tansaminase enzymes and alkaline phsopahatse. The safety of Rebamipide in pregnant and nursing mothers has not been established.
In the treatment of gastritis, acute or chronic, gastric ulcers and patients (arthritis patients) taking NSAIDs (non-steroidal anti-inflammatory drugs) who are now complaining of stomach pains, the usual adult dose is one Mucosta 100mg tablet in the morning, in the evening and before bedtime. And the other good news is that, Mucosta can be safely given with the patients' other anti-ulcer drugs.
In ulcers, just life in life, there is a time to hurt, a time to heal!
(August 29, 2006 issue)
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