Chapter 8Drugs for Gastrointestinal Disorders

Gastrointestinal (GI) Disorders Peptic ulcer diseaseGastroesophageal reflux diseaseDiarrheaConstipationIntestinal gas

Peptic Ulcer Disease (PUD)

Mucosa erosion stomach or duodenumOften asymptomatic Damage from Alcohol abuseCigarette smokingNSAIDs

Signs and symptoms of PUD Dull stomach achePoor appetiteBloatingBurping NauseaVomiting

Treatment Options for PUDDirected towards relieving pain, accelerating ulcer healing, and minimizing recurrenceH2 receptor antagonists (Tagamet, Zantac)Proton pump inhibitors (Prilosec, Prevacid)Antacids (Tums, Rolaids)Sucralfate (prescription only)Bismuth compounds (Pepto-Bismol)Antibiotics

Adverse EffectsDiarrheaConstipationHeadacheStomach crampsDizzinessRashNauseaVomiting

Gastroesophageal Reflux Disease (GERD)

Movement of gastric contents into the esophagusLower esophageal sphincter (LES) does not close properly

GERD (cont.)Possible problems with GERD Esophageal strictures (narrowing or constriction)Esophageal ulcersPerforationsHemorrhage AspirationMotility disorders

HeartburnMost common symptom of GERDPain in center of chestMost do not seek treatment right awayAggravated byFoods high in fat Spices, onions, citric juices, coffee (caffeine) Alcohol Body position

Treatment and Adverse EffectsGoals of treatmentEliminate symptomsLimit frequency and durationPromote healingPrevent complicationsAlter factors that cause refluxLose weight, proper dietLoose-fitting clothesLimit smoking, alcohol, laying down after eating

AntacidsRelieve mild to moderate symptomsDecrease gastric acidityRapid onset, short durationTaken with food = last up to 3 hoursAdverse effectsDiarrheaConstipation

Table 8-2: Antacid Classifications*

Diarrhea

Genetic DisorderAbnormal frequency and liquidity of fecal discharge Origin Infection (Salmonella)Toxic Drug-inducedDiet

Acute or ChronicAcute (sudden onset)Food induced (travelers)Chronic (2 weeks or longer)Stress or Irritable bowel syndrome

Treatment and Adverse Effects Goals of treatmentControl the loss of fluids (athletes)Identify and treat causeProvide symptomatic reliefRefer to physician ifPersists for several daysBlood in stoolSevere abdominal pain, crampsIf from a bacterial infection do not stop movement

Antiperistaltic agents (Imodium)Dizziness, dry mouth , rashBismuths (Pepto-Bismol)

Figure 8-1, pg 111

Constipation Decrease in the frequency of fecal elimination (hard/dry stool) Diet low in fiberLack of exerciseInsufficient fluid intakeExcessive intake of foods Resisting defecation impulses Diabetes, pregnancy

Antidiarrheal medicationsCan cause constipationLow back pain, headache, distension, abdominal pain

TreatmentIncrease fiber intakeBulk-forming laxatives FiberCon, Metamucil Increase fluid intakeAerobic exerciseStimulant laxatives Dulcolax Saline salt laxativesPhillips Milk of Magnesia/Fleet enema Implications for athletes, pg 113

Intestinal GasBelching, abdominal discomfort, bloating, flatulenceResults from malabsorption of carbohydrates and proteinsFruits, vegetables, lactoseSimethicone (Gas-X)Alpha-galactoside (Beano)

Athletic Trainers ResponsibilityRecognize and referTrusting relationship