Among the drugs that affect the digestive system, the antacid group is less common. The reason for this is the presence of other medicines that suppress acidoproduction. However, antacid drugs can also be applied, although noticeably less. In view of the safety, especially inherent in non-nursing antacids, their use is also expanding due to the contingent of pregnant women. In general, these are safe medicines that have clinical disadvantages, but there are objective advantages.
Because of the most important disadvantage, that is, the phenomenon of "ricochet", antacid drugs are noticeably less common in the treatment of esophageal, gastric and intestinal diseases. The essence of the "ricochet" is reduced to a compensatory increase in the amount of acid extracted by parietal gastral cells in response to its antacid neutralization. At first, the level of the gastric pH increases, but then acidity will increase (the pH will decrease even more than before). This limits the capabilities of antacids in disorders of acid formation.
The place of antacids in the pharmacological classification
The group of drugs affecting the secretory abilities of the stomach includes many substances, including the drugs of an antacid group. All gastrotropic drugs are divided by two types of use. The first is the means that compensate for the lack of secretion of the stomach contain enzymes and artificial gastric juice, as well as substances used in excess secretion. The latter include disadvantaged and suction antacids.
Insecursive constitute the bulk of the antacids, since they do not have a systemic effect. They do not violate blood pH and safely when using children and pregnant women. However, during lactation, they are not used irrational, since the lack of undesirable effects is not proven. Although theoretically, since they do not fall into the blood and cannot penetrate into breast milk, you can justify their safety and lactation.
Classification of antacids
All antacid drugs are divided into two heterogeneous groups: suction and disadvantaged substances. Their mechanisms of action are different because of this. At the number of suction include:
- sodium bicarbonate is the simplest antacid with a rapid effect, but the prone to form a foam in the stomach;
- magnesium oxide is a safer substance, but the prone to cause hypermagniasis;
- calcium carbonate (it is safer than magnesium oxide, although it is inclined to cause hypercalcemia);
- the main (alkaline) calcium carbonate is weaker, because it is safer compared to the previous one;
- the main (alkaline) magnesium carbonate is safer than magnesium oxide, and the same efficiency with alkaline calcium carbonate;
- bourge mixture (composition of sodium bicarbonate, sulfate and phosphate);
- mixtures of calcium and magnesium carbonates.
All specified antacid drugs are the names of the substances from which they consist. Only in the latter case, the mixture of antacid substances is the product name of the drug. This is Renny, "Andrews Antacid" and "Tams". However, in terms of efficiency, all the absorbable approximately the same, and the effect of reducing acidity they provide quickly. However, due to the violations of the blood plasma electrolyte profile, they are less safe than their unusable class analogs.
Non-surging antacids
These include insoluble magnesium compounds, calcium and aluminum, which, after flowing a chemical reaction with hydrochloric acid, do not form gas and not absorbed into the blood. These are more advanced antacid drugs, the list of which is represented as follows (according to the ATX code):
- A02AA - magnesium-based preparations;
- A02ab - based on aluminum and its insoluble salts;
- A02AC - calcium antacids;
- A02AD - antacids of combined composition comprising salts and complex compounds of aluminum, magnesium, calcium and silicates.
The most common now is aluminum-magnesium or aluminum-magnesium-calcium antacid drugs. This is explained by many positive effects from combination. Side effects are also mutually neutralized: the cells of magnesium are diarrhea, and in aluminum derivatives - constipation. Modern antacids are combined with spasmolitics.
Therapeutic groups of non-surging antacid drugs
The composition of insoluble antacids determines their therapeutic properties. Depending on this, the type of medication suitable for the treatment of a certain disease is selected. The composition of antacids may be like this:
- aluminum phosphates (Phosfalugel);
- algecedrat with magnesium hydroxide ("Almathel", "Palmagel", "Altacid", "Gastracide", "Alumag", "Malukol", "Maaloks");
- sodium-calcium combinations, aluminum-magnesium-silicate antacid drugs with alginate ("Gaviscon", "Topalkan");
- siemeticone in combination with aluminum-magnesium preparations (Almathel Neo, "Gesty", "Relzer").
Phosphalugel does not oversee the contents of the stomach and intestines and is most active at high acidity. What it is higher, the more important the therapeutic use of phosphhalugel. The second category of drugs is most often used in the treatment of ulcers and hyperacid gastritis. They are safe and efficient, although at very low pH values \u200b\u200bit is better to use aluminum phosphates.
The third category of drugs has an important feature: alginates prevent the cast of acidic content in the esophagus. By eliminating gastroesophaginal reflux, they effectively help in the treatment of GERD. On the one hand, these drugs neutralize acidity, and on the other, they protect the mucosa of the esophagus in its lower third of the aggressive impact of gastric content. All antacid preparations presented (examples) containing alginates are effective drugs for GERD.
Almagel Neo, "Relzer" or "Gestid" differ from the predecessors slightly. They are more like a second antacids group, that is, on a combination of insoluble salts of aluminum and magnesium. However, due to the presence of a "Simeticon" winder means, they eliminate meteorism. This effect is important from a clinical point of view for the reason that gases stretch the stomach and intestines, forcing the cells to produce acid. There is such a deficiency in the absorbing antacids, which he provokes the phenomenon of the Ricochet.
Other effects of antacids
Analyzing the substances on the basis of which antacid drugs were developed, their list of effects should be expanded. Their action is reduced not only to lower acidity due to chlorine binding, but also to protect the cells of the stomach mucosa. Such an effect is called gastrocytoprotection. It is maximally expressed in aluminum-containing antacids. Aluminum phosphate potentiates the speed of the synthesis of prostaglandins, due to which the frequency of cell divisions in the stomach increases. Also this substance is able to bind bile acids if they fall into the stomach.
In the intestine binding of bile acids is less important. In this way, the pathogen effect on the epithelium is thus reduced, which makes it possible to prevent the development of chronic gastritis like "C". It is due to the cast of bile in the stomach. But in the intestine, binding of bile acids leads to constipation. For this reason, aluminum-containing antacid drugs, the list of which is indicated above, must be combined with magnesium-containing. As can be seen, antacids are capable not only to neutralize the acid of the stomach, but also adjust the peristaltics of the intestinal tract and the recovery of the epithelium.
Indications
If you analyze antacid drugs, a list of their therapeutic and side effects, as well as the features of the composition and pharmacological action, one can determine the indications for their use. They depend on the specific type of antacid and a certain disease, as well as related states. Diseases requiring antacids are as follows:
- GERB (gastroesophaginal reflux disease);
- any diseases provoking GERB (Cardia Ahalasia, hernia of the esophageal aperture of the diaphragm);
- treatment of states after chemical or thermal burns of the esophagus;
- stomach ulcer;
- erosive gastropathy;
- duodenogastral reflux disease;
- paint ulcer.
All the above antacid drugs (list) are unsuitable for monotherapy of any of the listed diseases. The most competent treatment is their combination with means that reduce the secretion of hydrochloric acid. Preparations of the first row are they. These are L2 histamine receptor blockers and proton pump inhibitors. However, if necessary, antacid and antisecretory preparations are effectively combined, accelerating healing of ulcers and erosions.
Selection of antacids
Some antacid drugs whose names are indicated above should be considered as a means of choice for some pathologies. In particular, with GERD, it is rational to use combinations of aluminum-magnesium-silicate antacids with alginate. This is "Almatyel", "Palmagel", Altacid, Gastracide, Alumag, Maalukol, Maalox and other analogs in composition.
In case of chronic hyperacid gastritis of the type "C", as with any hyperacid states, it is reasonable to give the choice of Phosphalugel. It is also preferred with duodenogastral reflux. In other clinical situations, the choice depends on the accompanying states of the person. If it often occurs constipation, then preferably the purpose of magnesium antacids. In children it is better to apply aluminum magnesium drugs.
With the ulcer of the stomach and (or) of the 12rred intestine, any non-oxidic antacid drugs are used. The list of them is wide due to the presence of many commodity items. Often, initially one antacid with an anesthetic effect should be taken, and then use another substance without it. Anesthetic antacid is "Almagel A", which contains anesthesin (benzocaine). It must be taken 3-4 days if ulcers or erosion are accompanied by strong pains, and then replace to another antacid, without an analgesic substance. Without control of the doctor, it is allowed to take antacids no more than 14 days.
The use of antacids during pregnancy
All non-seated antacid drugs during pregnancy are safe, because they cannot be absorbed into the blood. The impossibility of providing a resorbative effect and provides this property. Therefore, in any period of pregnancy, antacid drugs, not suction in blood, can not harm neither the organism of the mother nor the fetus. The exception is a group of suction antacids, which theoretically cause harm due to disorders of electrolyte and acid-base equilibrium. Until the danger of the use of suction antacids during pregnancy is not excluded, from their use should be refused.
During lactation, the safety of the use of antacids remains uncertain. Tests with nursing women were not carried out, it means there is a chance to have unproved harmful effects. This risk is high in the absorbing antacids and theoretically, there must be absent from the universal. However, due to the lack of research information, as well as due to the lack of clinically significant experiments, to assign any antacid to a woman during lactation is contraindicated.
Application in pediatrics
In accordance with the legislative norms of the Russian Federation, the country is forbidden to give the proton pump inhibitors with young children. In this regard, in the occurrence of diseases of the stomach or 12-rosewoman, it is necessary to use antacids or H2 Blockers H2 histamine receptors. The impossibility of suction and the provision of a resorbative effect makes children's safe antacid drugs. They do not harm, do not damage the gastrointestinal tract, although they have some side effects.
Nevertheless, in pediatric practice, children's antacid drugs cannot be used widely, because there are only a small number of diseases that require their destination. In adult patients, on the contrary, the testimony is significantly more. Children are significantly less frequently incidents of the stomach, erosion, the diseases of the 12th-rosewoman. In addition, the use of aluminum-magnesium or exclusively aluminum disadvantaged antacids threatens constipation.
It is noteworthy that there are no suction antacid drugs for children. The reason for this is the risk of displacement of the electrolyte and acid-base balance. In children, normal concentrations change in smaller limits, because of which the risks of harm to the child with hypercalcemia, hypermagniasia or alkalosis is significantly higher than in an adult. Effective preparations in this case should be considered non-supersonic antacids that do not have sodium bicarbonates: "Almagel", "Alumag", "Maalox". "Phospholyugel" is not recommended to be applied due to the possibility of constipation.
Restrictions on the use of antacids
Antacid drugs, the classification of which indicates the presence of two types of drugs of the group, are somewhat limited to the application. This is due to pharmacokinetic and pharmacodynamic features, disorders of food suction and other medicines, as well as an infallible acid-based action. A short-term effect requiring frequent antacid use is also an important limitation of its application.
The duration of the acid-based action of non-surging antacids is 2-3 hours. Therefore, it becomes necessary to use them 4-6 times a day, which is inconvenient in practical terms. At the same time, in the case of the stomach ulcers or hyperacid gastritis, antacid means are capable of maintaining pH at 3-4. Without the use of drugs, the pH level is 1-1.5, which is characterized as a severe acidic medium.
A short-term reduction in acidity up to 3-4 units does not have an important therapeutic effect. And about 2 hours from the time of use, the pH values \u200b\u200bare restored. It means that the damaging factor provoking the emergence of chronic inflammation, erosion or ulcers, continues to operate. This characterizes antacids as defective and unsuccessful preparations for monotherapy of esophageal and gastric diseases.
Because of the pharmacological features described above, antacids gave way to the treatment of gastrointestinal diseases of histamine receptor blockers. The latter are less effective than modern proton pump inhibitors. Therefore, most often in the treatment of hyperacid states, ulcers and erosion preference is given to them. Examples of drugs are: "omeprazole", "Ezomeprazole", "Pantoprazole", "Lanzoprazole". They are moved well, have the minimum number of clinically significant side effects.
An objective place of antacid drugs
Evaluating the pharmacodynamic and pharmacokinetic features of the antacids, it is possible to make an obvious conclusion about the possible spheres of anticidal drugs. It is obvious that their effects are not enough for monotherapy of ulcers, erosive gastropathy, GERB. Therefore, only a few areas of clinical use remain only for non-surging antacids:
All antacid drugs (names are indicated above) are used mainly on an empty stomach, that is, 1 hour before meals or 2 hours after the last meal. They must be taken 4-6 times a day due to a short acid-based action. H + PAP or H2-receptors of histamine are used 1 time per day. Provided that antacids violate the absorption of other, more active drugs, they should not be used before taking proton pump inhibitors.
Also, antacids violate the absorption of antibiotics, can bind them and reduce their antibacterial activity in the treatment of helicobacter infection. In the case of the use of other drugs, it should be expected that against the background of the reception of non-seated antacids, the resorption of the remaining drugs is disturbed. Their therapeutic value drops significantly. Therefore, many clinicians recommend abandoning the appointment of antacid drugs if the level of plasma concentration of other drugs is of paramount importance.
Antacids are drugs that are prescribed for diseases of the gastrointestinal tract. These drugs help eliminate heartburn, pain and digestive disorders caused by excessive production of pancreatic juice.
Great, discomfort and digestion disorder causes excessive release of chlorogenic acid. In the treatment of this phenomenon, at elevated concentrations of hydrochloric acid, an antacid is assigned. Antacid drugs are designed to neutralize the effect of hydrochloric acid on the walls of the stomach and esophagus.
Structure
Antacid drugs that it is clear. Antacid (prescribe doctors) in their composition may contain additional components aimed at eliminating spasms and pain.
The active substances of such drugs are different compounds of alkaline earth metals. Many antacids preparations Contain additional components in the form of compounds of the windthorn, laxative, antispasmodic and anesthetic action.
An antacid tool may contain hydroxides, oxides, carbonates and metal peroxides. Phosphate, hydroxide and others may be present from aluminum compounds. These drugs exhibit a softer and slower action than calcium and sodium preparations, but their action is longer.
These compounds are insoluble in water, the blood plasma is practically not received and can be partially absorbed toxic compounds in the digestive tract.
How to act antacids
The mechanism of action directly depends on whether the compound of which metal is used as valid. The main effect of all drugs of this group is a neutralizing, eliminating the effect of hydrochloric acid. Additional actions depend on the metal based on the active substance.
Magnesium compounds There is a pronounced neutralizing effect, partial adsorbing, and practically do not have an enveloping and binder.
Calcium compounds Somewhat weaker in terms of neutralization, but possess similar adsorbing properties. Cytoprotective, binder and enveloping action practically do not have.
Aluminum compounds considered the most effective. They have a pronounced neutralizing effect, cytoprotective, actively adsorb, also have soft enveloping and astringent effects.
Bismuth antacids - This is a subgroup of antacids, which are more often used as adsorbents with cytoprotective and astringent action.
Indications for use
By defining what antacids are, find out for what purpose they are prescribed to patients. First of all, they are prescribed to neutralize excess hydrochloric acid in pancreatic juice - it is whether it contributes to the development of heartburn and ulcerations of mucous gastric shells.
Assigned for diseases that are accompanied by excessive pressure in the intestines and the stomach with a corresponding disturbance of the peristaltics.
Effective in spasms and caused by pain in the stomach, as well as during the emission of the contents of the duodenum in the stomach. It is important to understand that such antacid drugs play a key role in the treatment. gastroesophageal reflux disease and ezophagita - inflammatory disorders of the esophagus.
These drugs are prescribed only in cases where the gastrointestinal diseases are not complicated by the intestinal and stomach diseases.
Antacids: Classification
The classification of antacids is carried out by their ability to be absorbed into the blood and on the chemical composition of drugs. Classification of antacid means for the mechanism of action:
By chemical composition, they are divided into magnesium-containing, aluminum-containing, combined, in a separate group, the preparations of sodium hydrocabon and calcium carbonate are carried out.
Suction
Antacids — the list of preparations with an absorbent action often contains magnesium compounds. They act fairly quickly, but their action is short. The advantage of this subgroup is that acidity decreases rather quickly, which means that such an antacid means can quickly get rid of heartburn.
The disadvantage of suction drugs are adverse reactions, including not only allergic, but also specific, for example, acid ricochet. The combination of adverse reactions with short-term action makes the use of absorbing antacids less desirable than non-quasive.
What is an acidic ricochet
This phenomenon may cause such an antacid agent, which very quickly reduces the acidity of the stomach. This effect resembles the body's protective reaction to the action of rapid neutralizing agents. The body corresponds to the enhanced excretion of hydrochloric acid in response to a decrease in its concentration in the stomach.
A typical example of such an antacid - baking sodawhich is often used to eliminate heartburn. But the soda is an ineffective drug for the reason that it contributes to the formation of carbon dioxide in the stomach. The latter, in turn, provokes enhanced production of hydrochloric acid, and therefore causes a new heartburn.
The second reason why the use of soda from the point of view of the acid rickest is the sediment of sodium, which lead to the swelling, which is particularly undesirable during pregnancy and diseases of the cardiovascular system.
Antacid drugs
A list of drugs from a group of suction:
- Magnesia burned;
- Magnesium carbonate, Calcium;
- Burgo mixture;
- Vicalin;
- Renny;
- Vikair;
- Tums..
It is worth remembering that such antacids act in similarly to food soda and can cause the development of an acid ricochet, therefore the doctor's consultation is required before applying.
Antacid means: list of non-playing
The antacid drug of non-playing action works in two interrelated mechanisms. At first, he neutralizes excessive concentrations of hydrochloric acid, and then adsorb what is released by the stomach in response to neutralization.
It turns out that the adsorbing properties prevent the development of an acidic ricochet, and therefore, non-obsistent antacids are capable of experiencing less unwanted effects.
Antacida medications
List of drugs of non-surging antacids:
This is not an exhaustive list of antacid agents, a particular means can be selected by the doctor not from this list, but according to its own medical experience of treating increased acidity and caused by it.
Adverse reactions
Any drug from the list of antacids is carried out well enough, if it is properly assigned and not accepted. In rare cases, individual complications are developing after their use.
Extremely rarely develops intolerance, which manifests itself in the form of skin rashes, nausea, vomiting, swelling. Large dosages of drugs can cause lethargy and drowsiness.
Features of application
Despite the fact that the list of side effects is short enough, it is worth understanding that such antacid drugs as Renny, Phosfalugel And others can cause serious reactions if assigned erroneously.
For example, heartburn can develop as a result of power culture disorders, and it can become a symptom of serious pathologies of the stomach and intestines. In case of nutritional disorders, antacids are easily eliminated with heartburn, changing the acidity of the gastric juice, but in pathologies associated with the ulceration of the stomach walls, may cause serious adverse reactions.
Depending on the testimony, drugs of this group are taken from one week to a month, while symptoms will disappear completely.
With an isolated shape of heartburn caused by excessive use of soda or coffee, the antacids are selected from the list of suction.
Antacid means are prescribed to meals or after? It depends on the drug itself and pathology. For example, Phosfalugel It is more often recommended before meals, other antacids after meals.
Pregnant women
Antacids during pregnancy - allowed drugs, but only if they are used to prescribe the attending physician. Starting from the second trimester, women are increasingly noting the burning of the blade region - this is a hidden heartburn caused by consumption of oily or exotic food. Therefore, antacids become preparations of choice, but exclusively non-supersay.
For ulcerative disease
In the treatment of intestinal ulceration, preparations from a group of proton pump inhibitors are often used. The use of antacids in this case is undesirable, as it strongly reduces the effectiveness of antibacterial therapy.
Disadvantaged drugs, for example, Gastracide, AlmaGel And similar, apply if it is necessary to stop pain, if a small diameter ulcer. To relieve pain choose gel antacids with anesthetics. Also used to prevent recurrence and acid ricochet.
In chronic duodenitis
Applied as an auxiliary drug that reduces secretion, as well as additional adsorbents in acute duodenitis or gastroiodine. Used in exacerbation of duodenitis against the background of peptic diseases, pancreas pathologies or liver.
With ulcerative diseases and secondary duodenitis, it is used to eliminate discomfort and abdominal pain, gravity and suggestions in a short time. Also used to prevent the recurrences of chronic form duodenita and gastroduodenitis, Against the background of the use of anti-inflammatory drugs. The choice of drug at each stage of the disease is engaged in a gastroenterologist.
Do not use antacids yourself, without prior consultation with your doctor. Improper appointment of the drug without taking into account the characteristics of the disease can lead to the development of complications and the exacerbation of chronic pathologies of the gastrointestinal tract.
Periodically arising from heartburn, exhaust with sour flared, gastric colic, pain require antacids. Preparations included in the complex of treatment of diseases of the gastrointestinal tract (gastrointestinal tract) related to the effects of hydrochloric acid.
History of antacids
Gastric antacid diseases are treated for more than a century. The most famous can be found from any hostess - sodium bicarbonate (food soda). As a result of unwanted side effects, it is not recommended for treatment in pure form.
The emerging antisecretory agents at first sweating antacids. With their help, the products of the gastric enzyme - hydrochloric acid decreased. But they could not completely solve the problems associated with the disease.
Therefore, antacid drugs again occupied the leading position in the treatment of gastrointestinal diseases.
How are antacid drugs?
Modern pharmacology has developed new preparations of combined action. In addition to neutralization of hydrochloric acid, they perform the following functions:
- Adsorption.
- Reducing the severity of tissue damage (cytoprotective action).
- Enveloping.
- Increase the synthesis of glossoproteins of mucus.
- Binding of bile acid with lysolecitin.
- Stimulation of the secretion of bicarbonates.
- Prevention of capillary epithelium from ulzerogenic (side) factor.
- Prevent meteorism.
Types of antacid drugs
- Soluble (suction) - The substance itself or products resulting from its interaction with gastric acid dissolves in the blood.
Forming carbon dioxide contributes to the emergence of negative side effects. The stretched stomach causes acid secretion, the gastric content is subjected to retrograde promotion (gastroesophageal reflux).
- Baking soda
- Magnesium oxide (grazing magnesia, periclase)
- Bourge mixture (combination of Na + bicarbonate Na + phosphoric-acid Na)
- Renny
- Andrews Antacid
As a result of a very fast leaning of the gastric medium, there is a symptom of an "acid ricochet". Upon completion of the action of the medication, a secondary increase in the secretion of acid occurs. Neutralized when eating. Antacids containing CA are undesirable to take before bedtime.
Fast, but short efficiency.
- Not suction
- Phosfalugel - neutralization of acid without surning, does not affect the physiological process of digestion.
- Maaloks, Almaty, is an adsorbing, enveloping suspension with an analgesic effect.
- Gastracide - Tablets with a mint flavor, remove heartburn, pain attacks.
- Malukol, Alumag - Combined drugs manufactured in the form of chewable pills, gel, suspension. Possess adsorbing, choleretic, wind turntable, enveloping action.
- Altacid - produced in the form of chewing tablets, suspension.
Note: When receiving an antacid agent, its therapeutic effect lasts about 30 minutes.
Currently, there is a qualitative revision of many established ideas about acid-dependent diseases, the treatment and prevention of exacerbations. The authors of survey articles on these issues are about antacids or mention casual, or do not mention at all, and this is understandable. When the tendency to spontaneous healing of peptic ulcers was not known enough, antacid drugs were considered a reliable therapeutic agent for ulcers, since practical experience showed that they remove pain and contribute to the healing of ulcers. With the accumulation of knowledge about the strong tendency of the spontaneous healing and insufficient ability of antacid drugs to bind salt acid, these drugs were transferred to the class of "logical placebo", and then the conclusion was made that the short-term changes in the pH in the stomach were unable Ulcers and that the observed healing should be attributed to an exceptionally spontaneous process.
However, the first controlled studies on the action of antacid drugs for healing ulcers conducted in the United States (1977) showed that the peptic ulcer when applying antacid drugs heals faster than at placebo (Thus, the duodenal ulcers after 4 weeks of treatment with antacid drugs healed in 78% of cases, compared with placebo - 45% healing - Peterson W. Letal, 1977; and stomach ulcers in 89% of cases compared with 52% placebo - Littman a. Et al., 1977). Thus, proof was obtained that antacid drugs are in no way only "logical placebo" are drugs for the treatment of peptic ulcer with proven effectiveness. In subsequent years, these data was repeatedly reproduced both in relation to the ulcer of the duodenum and the stomach. An involuntary antacid effect was also proved and approximately the same effectiveness of antacids and Blockers H 2-receptors of histamine. The next question, which researchers solved - what should be the dose of antacid funds whether it should bind all the hydrochloric acid, which is produced by the stomach, it turned out that it should draw up a tenth of the dose that is necessary to neutralize all hydrochloric acid (i.e. from 90 to 120 mmol per day) so that the ulcer begged (Berndt H., 1985). From the series of these works it became clear that antacid drugs have their effect not only through the binding of hydrochloric acid (AREND R., ROESCH W., 1993).
In subsequent years it was found that antacid drugs:
adsorb bile acids and lysoletin (involved in the damage to the gastric and esophagus mucosa);
possess a protest effect associated with the stimulation of the synthesis of prostaglandins (and therefore have priority use in cases where the pathogenesis of ulcers or damage to the mucosa is associated with the weakening of the protective properties of the mucous);
have the ability to bind the epithelial growth factor and fix it in the area of \u200b\u200bthe ulcer defect, thereby stimulating local reparative regenerative processes, cell proliferation and angiogenesis. This most is given the possibility of full reduction of the mucous membrane in functionality, which should lead to the elongation of the period of remission. Thus, only the transfer of the pharmacological effects of antacid drugs shows a very wide range of their actions, which significantly distinguishes them among other anti-greene preparations.
Currently, acid-dependent diseases include not only those in which hydrochloric acid acts as a realizing factor, but also of the diseases in which hydrochloric acid supports the course (progression) of the disease and in the treatment of which without blockers of secretion (or acid binding) cannot be dispensed. All acid-dependent diseases can be divided into three groups:
I Group - Classic:
Stomach ulcer;
Ulceal duodenal disease;
Gastroesophageal reflux disease;
Zollinger-Ellison syndrome;
Ulcer with hyperthyroidism.
Group II - indirect:
Acute (aggravation of chronic) pancreatitis;
Reflux gastritis;
NPVP gastropathy.
III Group - Reflex:
Intestinal disorders (caused by hydrochloric acid hyperproduction);
Bilyary dysfunction (formed when acidic content in the bulb of the two-day intestine), etc.
In the treatment of these diseases, the main or noticeable influence has a blockade of hydrochloric acid. In general, the idea of \u200b\u200bacid-dependent diseases began to form more than 100 years ago, at the same time the main stimulants and structures were opened through which gastric secretion was carried out. However, the first drugs that effectively block gastric secretion appeared about 50 years ago, and the most effective means blocking the "proton pump" - only in recent years.
Relatively recently managed to refine the role Helicobacter pylori.in the genesis of ulcerative disease. In this regard, the tactics of the treatment of this disease changed. It was decided to eradication treatment - First, the American Gastroenterological Association in 1994, then European (Maastricht I, 1996) and Russian (1997). The European Association in 2000 (Maastricht II) conducted a correction of recommendations. Thus, today in accordance with modern ideas about the pathogenesis of the disease medical treatment is based on two main approaches:
1. Eradication drug therapy in case of infection detection Helicobacter pylori.(HP).
2. Effective suppression of gastric acid products with modern antisecretory drugs. It should be noted that the causal relationship of the sickness and HP (more than 90%) at first seemed very close.
The results of the latest large-scale studies in different countries of the world have shown that the share of ulcerative disease associated with the HP infection has 70-80% of duodenal ulcers and more than 50-60% of the stomach ulcers. This again allows us to talk about the multi-factority of pathogenetic mechanisms of damage to the gastrointestinal tract, and the complex therapy is considered as the basis for the treatment of these damage. According to modern ideas about the pathogenesis of ulcerative lesions of the stomach and duodenum, they are the result of an imbalance of aggression and protection factors, regardless of whether an imbalance is connected with increased secretion or with reduced mucous resistance. Currently, it is proved that scarring of ulcers occurs in all cases when it is possible to maintain the indicators of the intragastric pH\u003e 3 for 18 hours throughout the day. The list of drugs currently used for basic (i.e. aimed at suppressing acid-peptic aggression) therapy of ulcerative disease is represented by four groups of drugs: histamine-receptor-receptor blockers, proton pump blockers, anticholinergic media and antacid drugs.
These drugs differ among themselves according to the strength and duration of action aimed at increasing the intragastric pH, however, since the level of acid production in different patients of unequal, they need different degrees of acid products. When choosing one or another drug for the treatment of ulcerative lesions, it is necessary to take into account not only the intensity of acid formation, but also the staging of the flow of ulcers.
Currently allocate four stages of ulcers:
first - a duration of 48-72 hours, characterized by a breakthrough of the "protective barrier" on a limited section of the mucous membrane and the formation of an ulcer defect under the influence of aggressive gastric juice factors, with the distribution of a defect in the depth and to the parties.;
second stage it is called the stage of "fast regeneration" and lasts about two weeks. This stage begins with the restoration of equilibrium between the factors of aggression and the protection that the immune system takes on. Morphologically, this stage is characterized by the presence of necrotic masses that perform a defect, damaged vessels, pronounced edema of the mucous membrane in the near-oil zone with lymph and capillariostase. Macrophages, lymphocytes, plasma cells are attracted to the damage zone. The main biologically active factors acting at this stage are growth factors. The ulcer is cleared of decay products, the intensive processes of collagen formation and regeneration of the epithelium, endothelium and other cellular structures begin. These processes require significant energy costs, as evidenced by the intensive DNA synthesis, fixed after 12 hours after the formation of ulcers.
In the third stage (Slow regeneration or late healing), lasting 3-4 weeks, increases the activity of the immune system, growth factors continue to act, enzyme-hormonal factors, under the influence of the epithelization of ulcers, the reconstruction of microcirculation, the differentiation of cells and their functional "maturation" begins.
In the fourth stage , the duration of which is difficult to install, continues, and sometimes the restoration of the functional activity of the mucous membrane ends. From the completeness of these processes, the duration and resistance of remission depends (rarely, often, continuously recurrent types of the flow of ulcers or recovery). The allocation of stages of the flow of ulcers is an important achievement of recent times, which showed that ulcerogenesis is standard for all ulcers, and the healing of ulcers goes according to its laws, is not enough or completely independent of pathogenesis.
If speak about place of antacid drugs in ulcer therapy, they can be used:
In the form of a basic preparation at a low aggressiveness of the gastric juice;
In the second and third stages of ulcers in case of insufficient intensity of scarring of ulcers (as a means of stimulating regeneration processes due to the fixation of the growth factor);
In the fourth stage of ulcers for the completeness of the functional recovery of the mucous membrane;
During the cancellation of secretion blockers to prevent the "Ricochti" phenomenon.
In the second group of diseases caused by aggressive properties of gastric and duodenal content, the gastroesophageal reflux disease (GERD), the morphological essence of which constitutes degenerative changes in the esophagus associated with the cast and long exposure in it of the gastric, and in the case of a negotiated stomach and duodenal content.
It is necessary to increase the volume of gastric content due to hypersecretion and slow emptying of the stomach, an increase in the concentration of hydrochloric acid, bile acids, as well as an increase in intra-abdominal pressure. Today, in the treatment of GERD, the use of proton pump inhibitors is expected to obtain clinical and endoscopic remission, and then the transition to supporting doses that the patient should receive continuously long. At the same time, depending on the economic capabilities of the patient, it can dwell on the secretion blockers or on antacid drugs. Wherein preparations of selection from antacids are algic acid that keeps the drug on the surface of the contents of the stomach and with each reflux throws into the esophagus. In addition, modern disadvantaged antacids have the ability to bind bile acids, so in the conditions of the "alkaline" reflux they are pathogenetically substantiated.
Traditionally, all antacids are divided into absorbable and non-supersay. TO suctional antacid relate:
Sodium bicarbonate (soda - NaHCO 3);
Magnesium oxide (burned magnesia);
Magnesium carbonate main - MG (OH) 2, 4MGCO 3, H 2 OH;
Calcium carbonate main - Saco 3;
Bourge mixture (sulphate NA, phosphorous NA, Na bicarbonate);
Renny mixture (calcium carbonate + magnesium carbonate);
Blem mixture (calcium carbonate + magnesium carbonate). They neutralize hydrochloric acid, but their action is very short - sucking, they can significantly affect the exchange of electrolytes. Some of them possesses the phenomenon of "ricochet", i.e. Stimulates the gastric secretion, so their use should be symptomatic (before the symptom stop), usually it is one, two receptions or a short period of time (days) when their possible side effects are not developed.
So, together with obstetres studied the effectiveness of Renny mix in pregnant women to relieve heartburn. The drug turned out to be quite effective, while the calcium exchange turned out to be very stable. Non-surging antacids possess a greater buffer (neutralizing) capacity. Their duration reaches 2.5-3 hours.
They are divided into three groups:
1. Aluminum phosphoric acid salt.
2. Aluminum magnesium antacids (Almagel Neo, Almaty) .
3. Aluminum magnesium preparations with adding alginate.
The preparations of therapy groups are very actively used in various clinical forms of gastroesophageal reflux disease. Based on modern representations about GERD, they are successful and for a long time can be effective in the negative phase of the disease (both in the schemes "on demand" and in a constant variant). After the discovery of all clinical and pharmacological effects of antacids, interest in antacid drugs reinforced. Works appeared (O.N. Minushkin et al., 1996, 1998, 2001, 2002, 2003, 2004; A.A. Sheptulin et al., 1996, E.S. Riesh, E.E. Zvartau, 1998 ; V.T. Ivashkin et al., 2002; A.V. Okhlobystin, 2002; Yu.V. Vasilyev 2002, 2003, etc.), in which an attempt is made to determine the place of antacid drugs in the treatment of acid-dependent diseases. Back in 1990, TYTGAT et al., After analyzing the results of the treatment of GERD, proposed to use antacids in the treatment of I-II degree of the disease in the form of monotherapy. Other stages of the disease require a different approach, and, as a rule, a comprehensive effect. In the review (O.N. Minushkin et al., 1998) analyzed the effectiveness of the treatment of 206 patients with GERD of different ages and different degrees of defeat. Confirmed the effectiveness of monotherapy in the early stages of the disease, especially in patients of elderly, senile age and in children. In these situations, antacids should be preferred. In a number of works, the effectiveness of the antacids was compared with the effectiveness of the Blocators H 2-receptor of histamine both to stop clinical manifestations, and according to the dynamics of the morpho-endoscopic substrate, which we were tied with a protective effect. If we talk about ulcerative disease, then in cases where the disease is associated with Helicobacter pylori.The treatment should begin with the Eradication of HP, and in the future the therapy should be continued therapy by the secretion blockers to the scarring of ulcers, and then can be continued by antacids to prevent the "ricochet" syndrome or they can be added to treatment if the scarring process slows down or an ulcer turns out to be resistant to treatment.
If the ulcer is not associated with HP, then antacids can be used as monotherapy. (when it comes to small (up to 8 mm) duodenal ulcers, in patients with short ulcerative history) or in combination therapy When the protective effect is necessary. The introduction of antacids into a complex of treatment in patients with long-term ulcers (using the phenomenon of fixing the growth factor) is particularly shown.
In pediatric practice, antacids must be greater importance, since children's pathology develops in a growing body with a "unfinished" hormonal status, unstable secretion and motorcy, an imperfect blood circulation regulating system. In our two works (1996, 1998) analyzed the results of treatment of 433 children aged 6 to 15 years (pathology: erosive gastritis, duodenitis, reflux-esophagitis, peptic disease).
Shown notes aluminum / Magnesium-containing antacids in children are an effective means of treatment and prevention of "acid-dependent" pathology. They should be considered as a means of basic therapy, since they have acid-mealizing, protective, stimulating the growth factor of action and absorb bile acids. At the same time, the risk of developing side effects is minimal, since the direct link between the dose of the drug (which is characteristic of the blockers of the gastric secretion) and the effect is not. Finally, speaking about ulcers, antacids can and should be used as funds preventing the exacerbation. We carried out prophylactic treatment in 50 patients (dose of 800 mg and 1600 mg of the drug Magalfil-800) during the year, while ulcers did not recur in 66% of patients. Recurrements in patients who do not receive preventive treatment are developing in 80% of cases. The difference is reliable. I would like to note that in the treatment of reflux gastritis, where the main damaging factors are bile acids and lysoletin, antacids are drugs of choice and treatment, and in prevention. Preparations of other groups are relative (auxiliary, symptomatic). If we talk about acid-dependent diseases that occur with a violation of intestinal motility (constipation, indulgence), then the unusable antacids are very effective (when removed - antacids with a predominance of aluminum; during constipation - with a predominance of magnesium). In the treatment of pancreatitis and npvp-gastropathy antacids are of a slight value, since in these cases the blockade of the gastric secretion should be maximum and throughout all day, which is very difficult to provide antacids without serious side effects. Recently, an antacid drug has appeared on the domestic market "Almagel-Neo" which has an aluminum and magnesium hydroxide, presented in the optimal ratio. It is known that aluminum hydroxide determine the slow development of the effect and is able to cause constipation; On the contrary, the magnesium hydroxide leads to a rapid effect, but has a relaxing effect.
The combination of these components in Almaty-neo has an optimal healing effect and has the greatest antacid capacity, which provides a high acid-meteraulizing effect. Compared to the previously known suspension of Almagel in a new drug, the content of magnesium hydroxide was increased by 3.9 times and the Siemeticone defoamer was added, a beneficial effect on belching, meteorism - contributing to the rapid suction of the generated gas (Table 1). We conducted a study of the effectiveness of Almagel-neo in 20 patients with exacerbation of chronic gastritis and duodenitis. All patients had preserved or increased gastric secretion.
Estimated the influence of Almagel-Neo on:
Speed \u200b\u200band completeness of the relief of pain and symptoms of gastrointestinal dyspepsia;
Frequency and consistency of the chair, meteorism;
Speed \u200b\u200band duration of action at one time reception and coursework (estimated by an alkaline time of the intragastric pH-metry);
Fixed side effects and tolerance of the drug. AlmaGel-Neo was prescribed in the form of monotherapy at a dose of 2 bags 3 times a day for the first 3-5 days, then 1 sachet 3 times a day after 1 hour after meals (10-14 days).
The positive effect is obtained in 100% of patients, while good and excellent - in 70% of patients. The effectiveness of the antacid drug determines the rate of development of therapeutic action and the duration of the neutralization of hydrochloric acid. It is important that the clinical effect in the treatment of Almagelm neo was reached in a short time: pains were shoved in the first 3 days, gastric dyspepsia and meteorism - in the first 3-7 days. Almagel-Neo provided an action in 8-12 minutes, the duration of the effect is 3 hours. Alkaline time after receiving 20 ml of Almatiel-neo was an average of 40 minutes, while the pH increased to 5-7.2. The phenomenon of secondary increase in gastric secretion was absent. The drug was well tolerated, the dose of 3 bags per day did not provide an influence on the intestine motorcycle. In general, the effectiveness of the drug Almagel-Neo is estimated as high: the effect was achieved quickly, in the first 3 days, a sufficient dose is 30 ml of the drug per day, and in cases of pronounced asidism, the initial dose can be 60 ml. In general, making a conclusion about the place of antacid drugs in the treatment of gastroenterological pathology (acid-dependent diseases), it should be recognized that antacids continue to maintain the position conquered over decades, and with the discovery of new properties (protective effect, influence on the growth factor and absorption of bile acids) Passed and expanded. In addition, these drugs are relatively inexpensive and because patients are in demand.
Literature
1. Minskin O.N. And Dr. - Maalox in clinical practice. - M., 1996.
2. Minskin O.N. et al. - Modern aspects of antacid therapy - M., 1998.
3. Minskin O.N. - the place of modern antacid drugs in the treatment of acid-dependent diseases. - Lechera., 2001, 5-6, 8-10.
4. Minskin O.N. et al. - Almagel Neo in modern therapy of acid-dependent diseases. - XI Congress "Man and Medicine", 2004, p.154.
5. Minskin O.N., Elizabetina G.A. - Antacids in modern therapy of acid-dependent diseases. - Constive, No. 7, 2003, 8-10.
6. Sheptulin A.A. - Modern principles of pharmacotherapy of ulcerative disease .- Klin.Med., 1996, 8, 7-8.
7. Riesh E.S., Zvartau E.E. - Pharmacotherapy of peptic ulcer, M., 1998.
8. Ivashkin V.T. et al. - the place of antacids in modern therapy of ulcerative disease - RMW (Appendix), 2002, 4 (2), 42-46.
9. Okhlobystin A.V. - Modern possibilities of using antacid drugs - RMW (Appendix), 4 (2), 51-54.
10. Vasiliev Yu.V. - Antacid drugs in modern therapy of diseases of the upper departments of the gastrointestinal tract. - Cons. MED, (Appendix), №7, 2003, 3-7.
When casting the contents of the stomach impregnated with hydrochloric acid, heartburn appears in the esophagus - sensations of burning in the chest. Heartburn may be a symptom of various diseases of the digestive tract. For its elimination, antacids are often prescribed. The list of antacid drugs has no one dozen items, it is worth knowing what they all differ among themselves.
The pharmacy today presents a wide selection of antacid funds, which are available in various dosage forms: suspensions, tablets for resorption
Description of the pharmacological group
First you need to understand antacids what it is.
Antacid agents are medications that neutralize the hydrochloric acid of the gastric juice, as a result, its irritating effect on the mucous membrane of the digestive organs is reduced, the healing of damaged sites is accelerated.
These drugs begin to act quickly, usually within 5 minutes after adoption, but the effect of their non-lifework.
Important! Antacids do not eliminate the cause of heartburn, they only remove unpleasant sensations for a while. Therefore, they should not be made without appointing a doctor, since the burning of the sternum may indicate a dangerous disease, which without adequate treatment will progress and can cause serious complications.
Antacids have the following actions:
- neutralizes excess hydrochloric acid;
- reduces excessive pressure in the stomach and a 12-risen intestine;
- removes spastic reduction in the stomach;
- preplays the stomach of the contents of the 12-rosewoman in the stomach;
- accelerates the promotion of gastric content;
- modern medicines can sorbitize lysophosphatidylcholine and bile acids;
- cross the mucous membrane of the digestive tract and protect it from the effects of aggressive factors.
Antacid drugs are prescribed under the following pathologies:
- GERB and ulcers (as part of combined therapy to eliminate pain and heartburn);
- for therapy of acid-dependent pathologies in women in position;
- diseases of the stomach caused by the method of nonzeroids;
- as part of combined therapy in the exacerbation of the inflammation of the gallbladder, the pancreas, bile disease (they are prescribed for the binding of excess bile acids) and when the stomach disorder.
Also, they are prescribed to healthy people, whose heartburn is observed, for example, due to diet violations.
Classification
All antacid funds are divided into 2 groups:
- absorbable antacids;
- disadvantaged medicines.
Depending on the active substance, antacid drugs are divided into the following groups:
- magnesium-containing, active substances can be magnesium hydroxide and carbonate;
- bicarbonate of soda;
- calcium carbon dioxide;
- aluminum-containing, active substances that are aluminum hydroxide and phosphate;
- combined drugs, which in their composition has several active substances.
Suctional antacid means
What is it suctionable antacid drugs? The active substances of such medicines interacts with hydrochloric acid and then partially absorbed in the stomach and penetrates overall blood flow.
The advantages of such drugs include that they quickly get rid of acidity, and, consequently, from heartburn. But when they were taken, negative unwanted reactions are observed, in addition, they have a short-term effect, therefore they are prescribed less frequently than non-referring.
Separate absorbable antacids are reacted with hydrochloric acid, as a result, carbon dioxide is distinguished, which causes the stretching of the stomach and hydrochloric acid is produced again.
Important! For suction antacids, the phenomenon of the return or acidic ricochet is characteristic. It appears immediately after the completion of these medicines. The nutritional antacids include food soda, which is sodium bicarbonate. When it interacts with hydrochloric acid, carbon dioxide is formed, as a result, hydrochloric acid begins to stand out in large quantities and the heartburn appears again. Therefore, soda can not be used to eliminate heartburn. In addition, the sodium is adsorbed in the intestines, the resulting swelling appear, which is undesirable for patients with heart and kidney pathologies, and women in position.
Food soda applies to suction antacids
Such medicines include the following drugs:
- Vicair;
- Vicalin.
These are medicines, active substances that are:
- sodium bicarbonate;
- magnesium oxide;
- magnesium and calcium carbonate.
Important! Antacid drugs from this list can only be taken once, since with long-term reception, they cause the exacerbation and progression of diseases of the digestive tract, such as a stomach ulcer.
Insecual antacid means
Compared to absorbing medicines, non-playing antacids are more efficient and they have less unwanted reactions.
Depending on the composition of non-surging antacids, 3 groups of medicines are distinguished:
- The 2nd group is represented by aluminum-magnesium antacids, they include such drugs like Maalox, Almagel, etc.;
active substances of the 1st group is aluminum phosphate, this group refers, for example, gel antacid - phosphhalugel;
The 3rd group is represented by combined means, in addition to salts of aluminum and magnesium, other components have been added, this group includes gel antacids with anesthetics, preparations containing sytlecone, for example, AlmaGel Neo.
Almagel Neo - a combined antacid agent, which contains a symmetone that provides a windy action
The active substances of these funds are practically not adsorbed by the gastric mucosa, except for a small amount of aluminum, which is then displayed with urin. If a patient has a severe form of renal failure, the elimination of aluminum organism can be difficult and therefore such patients have such antacids prescribe with caution.
Insecual antacids neutralize not only hydrochloric acid, but pepsin and bile. Finding into the body, they envelop the gastric mucosa and thereby protect it from irritating substances, and also contribute to the healing of damaged tissues.
The therapeutic effect of them occurs within 15 minutes and can be maintained up to 2-4 hours.
Against the background of their reception, the following unwanted reactions may be observed:
- allergies that can manifest itself on the skin, in this case you need to stop taking antacids and consult a doctor for medical care;
- in individual intolerance, nausea may be marked, sometimes vomiting can be opened, which requires replacement of the drug;
- magnesium-containing antacids have a laxative effect and often can trigger the stomach disorders;
- antacids, active substances that are salts of aluminum or calcium can cause difficulties with the emptying of the intestine;
- when taking large dosages of the medicine, a state of light drillness may appear, there is a risk of developing it in persons suffering from kidney pathologies.
Rules for receiving antacids
Antacids are produced in the form of gel, chewing tablets, pills for resorption or suspension. In efficiency, different forms of one medicine are the same.
Dosage and multiplicity of reception is selected by the doctor individually. Usually antacids are recommended to take 1.5 -2 hours after meals and at night.
It should be remembered that antacids cannot be taken simultaneously with other medicines. It is explained by the fact that antacid funds will not allow them to succeed. Therefore, the interval between the reception of antacids and other drugs should be 2 hours.
Despite the fact that antacid drugs are released without a recipe to take them, without consulting the doctor can not, since only a specialist can make the correct diagnosis and appoint adequate therapy.