D4 Antacids (pH regulation of the stomach )

D4.1 pH plays an important role in human’s body

– effect on the activity of molecule enzymes
– controlling the activity of digestive enzymes
– pH is low (=2) in the stomach since it produces HCl from the cell called parietal cells
in gastric glands in the lining of the stomach wall

D4.2 acid in stomach

– the hydrochloric acid concentration of the stomach ranges from 0.03M to 0.003M
which corresponds to a pH range of about 1.5 to 2.5
– kill bacteria
– Provide the optimum environment for the action of digestive enzymes
– gastric juice: acid indigestion/ heart burn/ ucleration
– Dyspepsia（消化不不良）: used to refer to feelings of pain and discomfort in the
upper abdomen, including indigestion and heartburn.

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D4.3 causes of acid indigestion
– excess stomach acid result in a state of discomfort known as acid indigestion
– acid indigestion may result form a variety of factors including:
– overeating, alcohol consumption, eating certain foods, anxiety, smoking,
certain drugs: aspirin

D4.4.1 H2-receptor antagonist

– H2 receptor impede acid production in the stomach by blocking the actions of
histamine, a substance produced by the body that encourages acid secretion in the
stomach
– this histamine interaction leads to the release of acid into the stomach lumen
– A good drug to reduce stomach acid secretion is to block the histamine-H2
interaction

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– These drugs which are called H2-receptor antagonists cannot cure ulcers, but in
certain cases they are useful in reducing inflammation allowing the stomach to heal
– H2-receptor antagonists are effective only for duodenal ulcers, however, and have
little effort on stomach (gastric) ulcers
– Zantac (Ranitidin) as the example widely used

D4.5.1 H+/K+ ATPase

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 – the parietal cells pump H+ into the stomach lumen during the process of gastric
acid secretion
– one H+ pump, one K+ is pumped in the opposite direction so no charge build-up
– ATP, Energy carrier provides the energy for the movement of the ions
– H+/K+ ATPase

D4.5.2 Proton pump inhibitors

– Proton pump inhibitors reduce the production of acid by blocking the enzyme in the
wall of the stomach that produces acid
– Inhibitors do not neutralize excess acid but inhibit the initial production of HCL
– The reduction of acid prevents ulcers and allows any ulcers that exist in stomach ,
esophagus, stomach and duodenum to heal
– Proton pump inhibitors
– proton pump inhibitors are generally available only by prescription but low
doses of some products are now approved for over the counter use
– Commonly prescribed Proton Pump inhibitors include
– Rabeprazole (acipihex)

Agenda
– Lansoprazole (Prevacid)
– Omeprazole (Prilosec)
– Esomeprazole (Nexium)

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D.4.6 Antacid compounds

– antacids are weak bases that are used to neutralize excess stomach acid
– most antacids are weak inorganic bases CaCO3, NaHCO3
– common example
– active ingredient Na,Mg, Ca, Al, Bi (k 不不能太多)
– anion used： OH-, O2-, CO3 2- , HCO-, HPO3-

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D.4.7.1 Antacid reaction

– Antacid react with HCl

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D.4.7.2 Reaction of calcium
– higher pH is intestine: CaCl2+CO3 2-=CaCO3+Cl2
– Some unchanged calcium is absorbed by the gut, which can raise the pH of the
blood causing alkalosis- can affect protein
– Calcium is then removed through the renal system

D.4.7.3 Reaction of Magnesium

– Magnesium oxides, hydroxides and carbonate are poorly soluble, only Cl2 are
soluble
– Although non-absorbable, 5%-10% of Mg enter systemic circulation which is then
rapidly removed by kidney

D.4.7.4 Reaction of Aluminium

– Solubility of Al increases as pH decreases, above pH>5 neutralizing effect will stop

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– Inadequate amount of phosphate ions will cause Al3+ to be absorbed
– It will rebind back at soft tissue or bones where phosphates are found

D.4.8 Effect of antacids

– In addition to neutralizing excess stomach acid they may be helpful in preventing
inflammation, relieving pain and discomfort, and allowing the mucus layer in the
stomach lining to heal
– They are often used to treat ulcers by preventing the stomach acids from attacking
the stomach lining allowing it to heal

D.4.9 Side-Effect of antacids

– Antacids are relatively harmless but they can have minor contraindication
– Magnesium Compound may cause diarrhea
– Aluminum compounds may cause constipation and they may interfere with the
absorption of phosphate in the formation of bones. This is more likely to be true if
these compounds are taken for an extended period of time
– Carbonates may generate carbon dioxide leading to bloating and flatulence

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