Gastrointestinal disorders are conditions that affect the digestive system. GI health is crucial for overall well-being. A wide range of medicines and supplements are used to address undesirable conditions of the GI tract.
Antacids
These agents neutralize excess stomach acid. Systemic antacids include sodium bicarbonate and sodium citrate. Non-systemic antacids include aluminum hydroxide, magnesium hydroxide, magnesium trisilicate, and calcium carbonate. Combinations of antacids are frequently used, often incorporating aluminum and magnesium salts.
Why combinations of Antacids used?
- Magnesium salts act as laxatives, while aluminum salts tend to be constipating. These combinations can lead to a moderated effect on bowel movements.
- Magnesium hydroxide acts quickly, and aluminum salts act more slowly, resulting in a sustained effect.
- Gastric emptying is minimally affected.
- The dosage of individual components is reduced.
Antacids do not heal peptic ulcer-like diseases. They are widely used for relieving intercurrent pain, acidity, and providing fast relief from symptoms in cases of Gastroesophageal reflux. Antacids are available over the counter (OTC)
Proton pump inhibitors (PPIs)
PPIs (Proton Pump Inhibitors) are prescription medications that reduce stomach acid production by inhibiting the proton pump in the stomach lining. They are often used to treat peptic ulcers, bleeding peptic ulcers, stress ulcers, gastroesophageal reflux disease, Zollinger-Ellison syndrome, aspiration pneumonia, monotherapy for gastritis, nasogastric tube-induced ulcers, and drug-induced ulcers.
PPIs are considered safe during pregnancy. These drugs include Omeprazole, Lansoprazole, Pantoprazole, and Rabeprazole.
PPIs generally produce minimal adverse effects, which can include nausea, loose stools, headache, abdominal pain, muscle and joint pain, dizziness, and very rarely, rashes. A higher risk of pneumonia has been observed in users of omeprazole, esomeprazole, and pantoprazole.
H2 Blockes
These agents also help block the histamine receptor in the stomach, reducing gastric acid secretions. They are highly selective and include Ranitidine, Famotidine, Roxatidine, Nizatidine, and Cimetidine.
H2 blockers are used to treat duodenal ulcers, gastric ulcers, stress-induced ulcers, gastritis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, and for the prophylaxis of aspiration pneumonia. Adverse effects occur in less than 5% of cases.
Prostaglandin Analogue
Prostaglandins are lipid-derived compounds that have various Physiological function in the body including roles in inflammation, Blood flow regulation and Protection of gastric mucosa.PGE2 and PGI2 are produced in the gastric mucosa and play a protective role in the gastric lining by inhibiting acid secretions.
PGE2 analogues, including Dinoprostone, are used as uterine contractors and abortifacients in the first trimester.
PGE1 is used in peptic ulcer disease and constipation. This group includes Misoprostol, Alprostadil, and Lubiprostone. Lubiprostone is used in the treatment of constipation-dominant IBS, while Alprostadil is used for the treatment of erectile dysfunction and patent ductus arteriosus. The off-label use of Misoprostol promotes ripening and dilation of the cervix during labor, medical abortion, and the induction of labor.
Ulcer Protectives
Ulcer protectives, including Sucralfate, Colloidal bismuth subcitrate, and Bismuth subsalicylate, do not have acid-neutralizing action but instead delay gastric emptying. They are used for the treatment and prophylaxis of bile reflux, gastritis, and the prophylaxis of stress ulcers.
Colloidal bismuth subcitrate is a water-soluble compound that increases gastric mucosal production, precipitates mucus glycoproteins, coats ulcer bases, and directly inhibits H. pylori.
Prokinetic Agents
Prokinetic agents help improve gastrointestinal motility and are used in cases of gastroesophageal reflux, gastroparesis, and functional dyspepsia. These agents include Metoclopramide, Domperidone, Itopride, Mosapride, and Tegaserod.
They do not affect gastric acidity or promote healing; their primary role is to enhance gastric emptying. Metoclopramide is a dopamine blocker that can cross the blood-brain barrier and lead to brain toxicity.
Laxatives
These agents help relieve constipation. Increasing physical activity can reduce chronic constipation. Various agents used as laxatives include:
- Bulk-forming laxatives, such as Isabgol (Psyllium husk), Methylcellulose, and Sodium picosulfate.
- Osmotic laxatives, including Lactulose and Milk of Magnesia, which help produce soft stools.
- Stool softeners like Docusate sodium, Docusate calcium, and Dioctyl sodium sulfosuccinate, which interfere with fat absorption and do not have a rapid onset of action. They are considered safe during pregnancy.
- Stimulant purgatives, such as senna, Cascara, Castor oil, Mineral oil, and Phenolphthalein.
Stimulant purgatives are generally not used during pregnancy and for bedridden patients.
Anti diarrheal Medications
These medications help control diarrhea. In the case of infectious diarrhea, antibiotics such as ciprofloxacin and metronidazole are used. For non-infectious diarrhea, loperamide and diphenoxylate with atropine are commonly used. Other agents include clonidine, octreotide, polycarbophil, and pectin.
Probiotics
Probiotics are live microorganisms that help create a healthy environment in the gut and support the digestive system. They are mainly used in conditions like irritable bowel syndrome and antibiotic-associated diarrhea. Probiotics are available in various dosage forms.
Self-diagnosis and self-medication are not beneficial for gastrointestinal issues. It is always advisable to seek advice from a healthcare provider for a proper assessment and treatment.
