Antacids

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.

Heartburn, discomfort and indigestion are caused by excessive release of hydrochloric acid. In the treatment of this phenomenon at elevated concentrations of hydrochloric acid, an antacid is prescribed. Antacids are designed to neutralize the effect of hydrochloric acid on the walls of the stomach and esophagus.

Compound

Antacids what it is clear. Antacids (prescribed by doctors) may contain additional components aimed at eliminating spasms and pain.

The active ingredients of such preparations are various compounds of alkaline earth metals. Many antacid preparations contain additional components in the form of carminative, laxative, antispasmodic and anesthetic compounds.

The antacid may contain metal hydroxides, oxides, carbonates and peroxides. Of the aluminum compounds, phosphate, hydroxide, and others may be present. These drugs are milder and slower than calcium and sodium preparations, but their action is longer.

These compounds are insoluble in water, practically do not enter the blood plasma and are able to partially absorb toxic compounds in the digestive tract.

How Antacids Work

The mechanism of action directly depends on which metal compounds are used as active ones. The main action of all drugs in this group is the neutralizing, eliminating the effect of hydrochloric acid. Additional actions depend on the metal in the basis of the active substance.

Magnesium compounds have a pronounced neutralizing effect, partial adsorbing, and practically do not have an enveloping and astringent effect.

Calcium compounds somewhat weaker in terms of neutralization, but have similar adsorbing properties. They practically do not have a cytoprotective, astringent and enveloping effect.

Aluminum compounds considered to be the most effective. They have a pronounced neutralizing effect, cytoprotective, actively adsorb, and also have a mild enveloping and astringent effect.

Bismuth antacids- This is a subgroup of antacids, which are more often used as adsorbents with a cytoprotective and astringent effect.

Indications for use

Having determined what antacids are, we will 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 this that contributes to the development of heartburn and ulceration of the gastric mucosa.

They are prescribed for diseases that are accompanied by excessive pressure in the intestines and stomach with a corresponding violation of peristalsis.

They are effective for spasms and pains in the stomach caused by them, as well as for the ejection of the contents of the duodenum into the stomach. It is important to understand that such antacids play a key role in the treatment gastroesophageal reflux disease and esophagitis- inflammatory disorders of the esophagus.

These drugs are prescribed only in cases where gastrointestinal diseases are not complicated by peptic ulcers of the intestine and stomach.

Antacids: classification

Classification of antacids is carried out according to their ability to be absorbed into the blood and the chemical composition of the drugs. Classification of antacids according to the mechanism of action:

According to the chemical composition, they are divided into magnesium-containing, aluminum-containing, combined, sodium bicarbonate and calcium carbonate preparations are taken out into a separate group.

Absorbable

Antacids — the list of drugs with absorbable action often contains magnesium compounds. They act quickly enough, but their effect is short-lived. The advantage of this subgroup is that the acidity decreases quite quickly, which means that such an antacid is able to quickly get rid of heartburn.

The disadvantage of absorbable drugs are adverse reactions, including not only allergic, but also specific, for example, acid rebound. The combination of adverse reactions with a short duration of action makes the use of absorbable antacids less desirable than non-absorbable ones.

What is acid ricochet

This phenomenon can cause such an antacid agent, which very quickly reduces the acidity of the stomach. This effect is reminiscent of the body's defensive reaction to the action of fast neutralizing agents. The body responds with an increased release of hydrochloric acid in response to a decrease in its concentration in the stomach.

A typical example of such an antacid is baking soda, which is often used by the people to eliminate heartburn. But soda is an ineffective drug for the reason that it promotes the formation of carbon dioxide in the stomach. The latter, in turn, provokes an increased production of hydrochloric acid, which means it causes a new heartburn.

The second reason why the use of soda is undesirable in terms of acid rebound is sodium deposits, which lead to swelling, which is especially undesirable during pregnancy and diseases of the cardiovascular system.

The list of drugs from the group of absorbed:

Magnesia burnt;
magnesium carbonate,calcium;
Bourget Blend;
Vikalin;
Rennie;
Vikair;
Tums.

It is worth remembering that such antacids act similarly to baking soda and can cause the development of acid rebound, so a doctor's consultation is required before use.

Antacids: a list of non-absorbable

A non-absorbable antacid works by two interrelated mechanisms. First, it neutralizes excess concentrations of hydrochloric acid, and then adsorb what is secreted by the stomach in response to neutralization.

It turns out that the adsorbing properties prevent the development of acid rebound, which means that non-absorbable antacids are able to have fewer undesirable effects.

Antacid medicines

List of drugs of nonabsorbable antacids:

This is not an exhaustive list of antacids, a specific remedy can be selected by the attending physician not from this list, but according to their own medical experience in treating high acidity and the diseases caused by it.

Adverse reactions

Any drug on the list of antacids is well tolerated if correctly prescribed and not taken excessively. In rare cases, individual complications develop 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.

Application features

Despite the fact that the list of side effects is quite short, it should be understood that antacids such as Rennie, Phosphalugel and others, may cause serious reactions if administered incorrectly.

For example, heartburn can develop as a result of nutritional disorders, or it can become a symptom of serious pathologies of the stomach and intestines. With malnutrition, antacids easily eliminate heartburn by changing the acidity of gastric juice, but with pathologies associated with ulceration of the walls of the stomach, they can cause serious adverse reactions.

Depending on the indications, the drugs of this group are taken from one week to a month, until the symptoms disappear completely.

With an isolated form of heartburn caused by excessive consumption of soda or coffee, antacid preparations are chosen from the list of absorbable ones.

Are antacids given before meals or after? It depends on the drug itself and the pathology. For example, Phosphalugel more often recommended before meals, other antacids - after meals.

Pregnant women

Antacids during pregnancy are allowed drugs, but only if they are used as prescribed by the attending physician. Starting from the second trimester, women increasingly notice a burning sensation in the retrosternal region - this is a hidden heartburn caused by eating fatty or exotic foods. Therefore, antacids become the drugs of choice, but exclusively non-absorbable.

With peptic ulcer

In the treatment of intestinal ulceration, drugs from the group of proton pump inhibitors are more often used. The use of antacids in this case is undesirable, as it greatly reduces the effectiveness of antibiotic therapy.

Non-absorbable drugs such as gastracid, Almagel and similar ones are used if it is necessary to stop pain, if the ulcer is of small diameter. To relieve pain, gel antacids with anesthetics are chosen. Also used to prevent relapse and acid rebound.

With chronic duodenitis

They are used as an auxiliary drug that reduces secretion, as well as additional adsorbents for acute duodenitis or gastroduodenitis. They are used for exacerbation of duodenitis against the background of peptic ulcers, pathologies of the pancreas or liver.

In peptic ulcers and secondary duodenitis, it is used to eliminate discomfort and pain in the abdomen, heaviness and satiety in a short time. Also used to prevent recurrence of the chronic form duodenitis and gastroduodenitis, against the background of the use of anti-inflammatory drugs. The gastroenterologist is engaged in the choice of the drug at each stage of the disease.

Do not use antacids on your own without first talking to your doctor. Incorrect prescription of the drug without taking into account the characteristics of the disease can lead to the development of complications and exacerbation of chronic pathologies of the gastrointestinal tract.

When the contents of the stomach soaked in hydrochloric acid are thrown into the esophagus, heartburn appears - a burning sensation in the chest. Heartburn can be a symptom of various diseases of the digestive tract. To eliminate it, antacids are often prescribed. The list of antacids includes more than a dozen items, it is worth knowing how they all differ from each other.

The pharmacy today offers a wide selection of antacids, which are available in various dosage forms: suspensions, lozenges

Description of the pharmacological group

First you need to understand what antacids are.

Antacids are medicines that neutralize the hydrochloric acid of gastric juice, as a result, its irritating effect on the mucous membrane of the digestive organs decreases, pain disappears, healing of damaged areas is accelerated.

These drugs begin to work quickly, usually within 5 minutes of being taken, but the effect is short-lived.

Important! Antacids do not eliminate the cause of heartburn, they only temporarily remove discomfort. Therefore, they should not be taken without a doctor's prescription, since burning behind the sternum may indicate a dangerous disease that, without adequate treatment, will progress and can cause serious complications.

Antacids do the following:

neutralizes excess hydrochloric acid;
lowers excessive pressure in the stomach and duodenum;
removes spastic contraction of the stomach;
prevents the contents of the duodenum from being thrown into the stomach;
accelerates the promotion of gastric contents;
modern medicines can absorb lysophosphatidylcholine and bile acids;
envelop the mucous membrane of the digestive tract and protect it from the effects of aggressive factors.

Antacids are prescribed for the following pathologies:

GERD and ulcer (in combination therapy for pain and heartburn);
for the treatment of acid-dependent pathologies in women in position;
diseases of the stomach caused by taking nonsteroidal drugs;
as part of combination therapy for exacerbation of inflammation of the gallbladder, pancreas, cholelithiasis (they are prescribed to bind excess bile acids) and indigestion.

They are also prescribed to healthy people who experience heartburn once, for example, due to dietary disorders.

Classification

All antacids are divided into 2 groups:

absorbable antacids;
nonabsorbable drugs.

Depending on the active substance, antacids are divided into the following groups:

magnesium-containing, active substances can be magnesium hydroxide and carbonate;
bicarbonate of soda;
calcium carbonate;
aluminum-containing active ingredients, which are aluminum hydroxide and phosphate;
combined preparations, which in its composition has several active substances.

Suction antacids

What are absorbable antacids? The active substances of such medicines interact with hydrochloric acid and are then partially absorbed in the stomach and penetrate into the general bloodstream.

The advantages of such drugs include that they quickly relieve acidity, and, consequently, heartburn. But when they are taken, negative adverse reactions are observed, in addition, they have a short-term effect, so they are prescribed less frequently than non-absorbable ones.

Some absorbable antacids react with hydrochloric acid, resulting in the release of carbon dioxide, which causes distension of the stomach and hydrochloric acid is produced again.

Important! Suction antacids are characterized by the phenomenon of recoil or acid rebound. It appears immediately after the end of the action of these medicines. Absorbable antacids include baking soda, which is sodium bicarbonate. When it interacts with hydrochloric acid, carbon dioxide is formed, as a result, hydrochloric acid begins to be released in large quantities and heartburn reappears. Therefore, soda should not be often used to eliminate heartburn. In addition, sodium is adsorbed in the intestine, resulting in edema, which is undesirable for patients with pathologies of the heart and kidneys, and women in position.

Absorbable antacids include baking soda

These medicines include the following drugs:

Vikair;
Vikalin.

These are medicines, active substances, which are:

sodium bicarbonate;
magnesium oxide;
magnesium and calcium carbonate.

Their mechanism of action is the same as that of baking soda, but when neutralizing hydrochloric acid, no carbon dioxide is released, which positively affects the well-being of the patient who takes them. But the therapeutic effect of them is short-lived.

Important! Antacids from this list can only be taken once, since with prolonged use they cause exacerbation and progression of diseases of the digestive tract, such as stomach ulcers.

Non-absorbable antacids

Compared to absorbable drugs, nonabsorbable antacids appear to be more effective and have fewer adverse reactions.

Depending on the composition of non-absorbable antacids, there are 3 groups of medicines:

active substances of the 1st group is aluminum phosphate, this group includes, for example, gel antacid - Phosphalugel;

The 2nd group is represented by aluminum-magnesium antacids, these include drugs such as Maalox, Almagel, etc.;

The 3rd group is represented by combined agents, in which, in addition to aluminum and magnesium salts, other components are added, this group includes gel antacids with anesthetics, preparations containing simethicone, for example, Almagel Neo.

Almagel Neo is a combined antacid that contains simethicone, which has a carminative effect.

The active substances of these drugs are practically not adsorbed by the gastric mucosa, except for a small amount of aluminum, which is then excreted in the urine. If the patient has a severe form of renal failure, excretion of aluminum from the body can be difficult, and therefore such antacids are prescribed with caution in such patients.

Non-absorbable antacids neutralize not only hydrochloric acid, but pepsin and bile. Once in 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 last up to 2-4 hours.

Against the background of their reception, the following undesirable reactions can be observed:

allergies, which can manifest as a skin rash, in which case you need to stop taking antacids and consult a doctor for medical help;
with individual intolerance, nausea may occur, sometimes vomiting may open, which requires the replacement of the drug;
magnesium-containing antacids have a laxative effect and can often provoke indigestion;
antacids, the active substances of which are aluminum or calcium salts can cause difficulties with bowel movements;
when taking large doses of the drug, a state of mild drowsiness may appear, especially there is a risk of this in people suffering from kidney pathologies.

Rules for taking antacids

Antacids are available as a gel, chewable, lozenge, or suspension. In terms of effectiveness, different forms of the same medication are the same.

Dosage and frequency of administration is selected by the doctor individually. Usually antacids are recommended to be taken 1.5-2 hours after a meal and at night.

It must be remembered that antacids should not be taken simultaneously with other medicines. This is explained by the fact that antacids will not allow them to be absorbed. Therefore, the interval between taking antacids and other drugs should be 2 hours.

Despite the fact that antacids are available without a prescription, it is impossible to take them without consulting a doctor, since only a specialist can make a correct diagnosis and prescribe adequate therapy.

The possibility of a rapid therapeutic effect, primarily in the elimination (reduction of intensity) of heartburn and pain, after taking antacid preparations per os has long attracted the attention of doctors and researchers. This quality of antacids distinguishes them from drugs of other classes, including H 2 blockers of histamine receptors and proton pump inhibitors, the use of which in the treatment of patients can significantly reduce acid formation in the stomach, but the effect of their action occurs somewhat later, and the financial cost is much higher. .

The main point of application of antacids is the neutralization of hydrochloric acid secreted by the parietal cells of the gastric mucosa. According to the observations of some researchers, when taking antacids in normal therapeutic dosages, the acidity level is no more than 5 (the drugs neutralize only the excess acidity of gastric juice), however, when the acidity level drops to 1.3-2.3, these drugs neutralize 90% of the gastric juice, and at a value of 3.3 - 99% of gastric juice.

Antacids have long been used in the treatment of patients suffering from various gastroenterological diseases, primarily acid-dependent diseases. Currently, acid-dependent diseases include a large group of diseases of the upper gastrointestinal tract, regardless of whether the factor of acid aggression is central or only additional, leading to the onset and progression of these disorders. Among acid-dependent diseases, gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), non-ulcer (functional, essential) dyspepsia (NFD), pancreatitis, ulcers associated with non-steroidal anti-inflammatory drugs (NSAIDs), Zollinger-Ellison syndrome are most often distinguished. Some researchers also include ulcers, which can occur with hyperthyroidism, to acid-dependent diseases. In our opinion, these disorders can also include an idiopathic hypersecretory state, peptic ulcers of gastroenteroanastomosis that occur in some patients after gastric resection, and, to some extent, Cushing's ulcers, as well as ulcers that appear with celiac enteropathy.

In the treatment of patients suffering from acid-dependent diseases, various antacid preparations are used, which differ to a greater or lesser extent from each other, primarily in composition, speed of onset of the therapeutic effect, duration and effectiveness of exposure. These qualities of drugs to some extent depend on their form (tablet, gel, suspension). However, most modern antacid drugs have something in common - a decrease in the concentration of hydrogen ions in the stomach, resulting from the neutralization of hydrochloric acid; in addition, the neutralizing effect causes a decrease in peptic activity. In addition, in the stomach, antacids bind bile acids and lezolecithin, providing an enveloping effect. Some of the antacid preparations (in particular, those containing aluminum hydroxide) also have a cytoprotective effect, which consists in increasing the secretion of mucus and the synthesis of prostaglandins. It also turned out that antacids are able to bind epithelial growth factor and fix it in the area of the ulcer, stimulating cell proliferation, angiogenesis and tissue regeneration.

Taking into account the antagonistic effect of magnesia intravenously introduced into the stomach on the hypersecretion of acid caused by calcium carbonate, agents containing a mixture of calcium carbonate and magnesium oxide hydrate were created. However, these antacids do not eliminate the stimulating effect of calcium carbonate on gastric acid secretion. In addition, antacid preparations containing calcium carbonate, when interacting with hydrochloric acid in the stomach, cause the formation of a significant amount of carbon dioxide, which leads to the appearance or intensification of flatulence, and in the presence of cardia insufficiency, including that combined with hiatal hernia, - belching.

The stimulating effect of some antacids on gastric acid secretion is partly associated with alkalinization of the antrum, the release of gastrin and possibly other neurohormonal factors, and partly with the direct effect of these antacids on the parietal cells of the gastric mucosa.

Repeated attempts have been made to somehow classify antacids (absorbable and non-absorbable, local and systemic action, anionic and cationic, combined and monocomponent). The most commonly isolated absorbable and non-absorbable antacids. The group of absorbable drugs usually includes drugs such as sodium bicarbonate (soda), magnesium calcium carbonate basic - a mixture of Mg (OH) 2, 4MgCO 3, H 2 O, magnesium oxide (burnt magnesia), calcium carbonate basic - CaCO 3, a mixture of Bourget (Na sulphate, Na phosphate and Na bicarbonate), Rennie mixture (calcium carbonate and magnesium carbonate), Tams mixture (calcium carbonate and magnesium carbonate). These antacid drugs are characterized by the relative speed of the onset of the therapeutic effect (the disadvantage is the short duration of neutralization of hydrochloric acid). Usually, these drugs, having a systemic effect, increase the alkaline reserves of plasma, changing the acid-base balance, and neutralize (with local action) hydrochloric acid in the stomach, which in some cases can lead to the "acid rebound" syndrome due to the persistent appearance of acid hypersecretion in the stomach. after taking such antacids. In particular, these antacid preparations include calcium carbonate, which, shortly after ingestion, begins to stimulate the secretion of acid in the stomach - accelerated neutralization of hydrochloric acid in the stomach, activates an increase in its secretion by the parietal cells of the gastric mucosa. In this regard, calcium carbonate is currently very rarely used in the treatment of patients.

The group of non-absorbable antacids most often includes drugs such as phosphalugel (aluminum salt of phosphoric acid), the so-called aluminum-magnesium antacids (maalox, almagel neo, talcid, protab, magalfil, etc.) and aluminum-magnesium antacids with the addition of alginate (topalkan). A common feature of the primary action of this group of drugs (when entering the stomach) is an adsorbing effect on hydrochloric acid, followed by its neutralization. Unlike absorbable antacids, non-absorbable antacids have a longer antisecretory (neutralizing) effect (up to 2-3 hours), do not cause changes in acid-base balance and do not lead to an increase in the pH of gastric contents above a neutral value, without causing the "acid acid" syndrome. ricochet."

Modern antacid preparations differ from each other in the composition of cations (magnesium, calcium, aluminum), which largely determines their main properties (neutralizing, adsorbing, enveloping, astringent and cytoprotective action).

Unlike monocomponent antacids, combined antacids consist of several components and have different properties, depending on the composition. Sometimes aluminum-containing preparations are isolated (phosphalugel, maalox, almagel, gelusil varnish, talcid, etc.), one of the significant advantages of which, along with the neutralization of hydrochloric acid in the lumen of the stomach, is the protection of the mucous membrane of the esophagus and stomach from the effects of acid-peptic factor. Combined antacid preparations, especially those containing aluminum in their composition, have different mechanisms of action, including a combination that provides neutralization of hydrochloric acid and an increase in the protective properties of the mucous membrane, i.e., apparently, they also have a cytoprotective effect.

When evaluating the effectiveness of antacids, their acid-neutralizing ability and duration of action are most often taken into account. This fact is very important: the duration of antacid exposure is one of the main factors in assessing the therapeutic efficacy of antacid drugs used in the treatment of patients. It is known that antacids, due to their ability to be adsorbed on the gastric mucosa, cause a persistent acid-neutralizing effect, allowing them to exhibit buffering properties at a level of 2.4 pH.

The acid-neutralizing activity of various antacids ranges from less than 20 mmol/15 ml of an antacid preparation to 100 mmol/15 ml. Under the acid-neutralizing ability (activity) of antacids is usually understood as the amount of a particular antacid drug in grams or mmol / l, necessary to achieve a pH level of 50 ml of a 0.1N hydrochloric acid solution to 3.5.

Among antacids, agents associated with the calcium carbonate group have the shortest duration of action, a slightly longer duration with the magnesium group, and an even longer duration with the phosphorus group (up to 90 minutes). There are other data on the duration of action of antacids, in particular those containing aluminum phosphate, which have an antacid effect due to their absorption on the gastric mucosa, which prolongs the duration of their buffering capacity at a pH value of 2.4 to 120 minutes.

According to a number of researchers, combinations of aluminum and magnesium hydroxides, as well as calcium and magnesium carbonates, mainly exhibit only a neutralizing activity, which also includes an accelerated passage of food through the stomach. The study of the properties of some antacid preparations, according to intragastric computer pH-metry, using a 3-electrode pH probe, showed that the shortest time from the beginning of the administration of an antacid preparation to an increase in pH (8.9 minutes on average) was found in Maalox, the longest time was in Almagel (on average 13.5 minutes) compared with Remagel, Phosphalugel, Megalac; the average duration of the alkalizing effect (alkaline time - from the beginning of the pH increase to the return to the initial level) for antacids ranged from 28 minutes for Almagel to 56 minutes for Maalox. At the same time, Remagel, Phosphalugel, and Megalac occupied an intermediate position between Almagel and Maalox. The analysis of pH-grams showed that the maximum pH values after taking various antacid drugs differed slightly.

Therapy with antacids

Antacids can be successfully used in the drug therapy of all acid-dependent diseases in the following cases: 1) as monotherapy in the initial stages of these diseases; 2) as additional means (for example, in the treatment of patients with blockers of H 2 receptors of histamine or prokinetics); 3) as a symptomatic remedy for the elimination (reduction of intensity) of heartburn and pain behind the sternum and / or in the epigastric region, both during the treatment of patients, combining their intake with other drugs, and during remission (including as therapy " on demand"); 4) during the screening phase before the start of the proposed treatment, when selecting patients for randomized trials to study the efficacy and safety of certain medications or regimens for their use (as a rule, taking antacids is allowed according to the protocols of these studies), as well as directly during the timing of such studies as emergency therapy in cases where the efficacy and safety of prokinetics, H 2 -blockers of histamine receptors, proton pump inhibitors or so-called cytoprotective drugs are being studied.

In such cases, the undoubted advantage of antacids is taken into account - the rapid elimination (decrease in intensity) of heartburn (burning) behind the sternum and / or in the epigastric region and other gastrointestinal symptoms caused by the disease itself, for which patients are being treated, taking medications and intoxication .

One of the antacid drugs that periodically attracts the attention of researchers and doctors is phosphalugel (colloidal aluminum phosphate in the form of a gel for oral administration, containing 8.8 g in one sachet). Phosphalugel is more often referred to as a group of non-absorbable antacids. Most of the aluminum phosphate gel is insoluble, however, at a pH of less than 2.5, phosphalugel turns into water-soluble ammonium chloride, some of which is able to dissolve, after which further dissolution of aluminum phosphate is suspended. A gradual decrease in the level of acidity of gastric contents to pH 3.0 does not lead to the occurrence of an "acid rebound": the use of phosphalugel in the treatment of patients does not entail the appearance of secondary hypersecretion of hydrochloric acid.

One of the advantages of phosphalugel is that its acid-neutralizing ability depends on the level of acidity: the higher the acidity, the more active the effect of this drug. An increase in pH under the action of the drug leads to a decrease in the proteolytic activity of pepsin. The drug does not cause alkalization of gastric juice, does not limit enzymatic processes and does not violate the physiological conditions of the digestion process. Long-term use of the drug does not affect the metabolism of phosphorus. The actual effect of phosphalugel, which is in the form of hydrophilic colloidal micelles of the drug, is determined by colloidal aluminum phosphate, which has an antacid, enveloping and adsorbing effect. An insignificant part of phosphalugel is precipitated in the intestine in the form of oxides and insoluble carbonates, which enhances its protective, adsorbing and antacid effect. One gram of aluminum phosphate gel micelles, consisting of aluminum phosphate, agar gel and pectin, has a contact surface of about 1000 m², which provides an intensive connection with the walls of the digestive tract and the adsorption of harmful substances. Pectin and agar-agar gels, which are part of the preparation, are involved in the formation of a mucoid, antipeptic protective layer in the gastrointestinal tract. Colloidal aluminum phosphate binds endogenous and exogenous toxins, bacteria, viruses, gases formed as a result of putrefaction and pathological fermentation throughout the entire gastrointestinal tract, normalizing their passage through the intestines and thereby facilitating their removal from the body of patients. Under the influence of the drug, pain sensations are also weakened. Adults and children over 6 years of age are usually prescribed 1-2 sachets 2-3 times a day immediately after meals and at night (for reflux esophagitis) or more often (for other diseases) - 1-2 hours after meals.

One of the antacids that has recently also attracted the attention of doctors is hydrotalcite (rutacid, talcid), a drug with a low content of aluminum and magnesium. Among the features of the mechanism of action of this drug is the gradual release of aluminum and magnesium ions, depending on the pH of the gastric contents. Other advantages of hydrotalcite are fast and long-term neutralization of hydrochloric acid with maintaining a pH close to normal levels, a protective effect on the gastric mucosa with a decrease in the proteolytic activity of pepsin, binding of bile acids, and the form of the drug release - in the form of chewable tablets, which should be chewed thoroughly. . In the treatment of adult patients, hydrotalcite is usually prescribed 500-1000 mg (1-2 tablets) 3-4 times a day 1 hour after meals and at bedtime; after errors in the diet, accompanied by the appearance of symptoms of discomfort, as well as alcohol abuse - 1-2 tablets once. For children aged 6-12 years, the dosage is reduced by 2 times. The duration of treatment is determined by the general condition of the patients. It is not recommended to take this drug at the same time as drinking acidic drinks (juices, wine).

It is known that, along with dyspeptic disorders, usually associated with various diseases of the esophagus and stomach, a significant part of patients are worried about flatulence that occurs due to various reasons, including in patients, according to our observations, who have been taking proton pump inhibitors for a long time. The appearance on the domestic market of Russia of a new antacid water-soluble drug almagel neo, containing in its composition the optimal amount of aluminum hydroxide and magnesium hydroxide (compared to the previously well-known suspension of almagel, the content of the latter is increased by 3.9 times) and introduced into its composition simethicone (antifoam) , allows patients with preserved and increased secretion of the stomach to receive a positive effect in eliminating the symptoms of discomfort, including flatulence, in a short time (on average, on the fifth to seventh day); only in cases of severe symptoms of flatulence, treatment of patients with almagel neo should be started with the use of 60 ml / day. The effectiveness of this drug is due to its high acid-neutralizing ability, the presence in its composition of simethicone (a surfactant that reduces the external tension of gas bubbles), which promotes the natural release of intestinal gases and their absorption, which to a certain extent prevents the occurrence of stool retention (constipation) and flatulence , reduces the likelihood of belching. The presence of neosorbitol in Almagel makes it possible to use it in the treatment of patients who, along with one of the acid-dependent diseases, also have diabetes mellitus. Usual dosages for prescribing this drug to patients: inside for adults 1 sachet or 2 dosing spoons 4 times / day 1 hour after meals and at night; for children over 10 years old, the dosage of the drug is determined by the attending physician (taking into account the body weight and condition of the child).

There are different options for prescribing antacids to patients for various diseases, but most often antacids are prescribed in the following cases: with the so-called "on demand" therapy for the rapid elimination (reduction of intensity) of dyspepsia symptoms, primarily heartburn and pain (at any time of the day) ; in a course of treatment 30-40 minutes before or 30-60 minutes after a meal (if necessary, and at bedtime) as monotherapy or in complex treatment, in combination, primarily with prokinetics and / or H 2 -blockers of histamine receptors (the frequency and duration of taking antacids are determined by the general condition of patients). By itself, the positive effect of antacids in eliminating pain behind the sternum and / or in the epigastric region and / or heartburn (burning) indicates the presence of an acid-dependent disease in a patient. Most often, as observations show, antacids may be necessary in the treatment of patients suffering from peptic ulcer, chronic pancreatitis, GERD and / or NFD, which can either be combined with chronic hyperacid or normacid gastritis, and is possible in patients with NFD syndrome without morphological signs of gastritis.

As our observations have shown, it is most appropriate to use antacids in the following cases. In case of peptic ulcer associated with Helicobacter pylori (HP), after eradication therapy, if patients develop pain and / or dyspeptic disorders, especially heartburn. However, due to the adsorbing ability of antacids, their use directly during the eradication therapy of Helicobacter pylori is not justified: during this period, patients take quite a lot of tablets or capsules - 6 times a day, the basic drug (proton pump inhibitor, ranitidine or bismuth drug) in combination with 2 antibiotics (first-line therapy) or 4 drugs 13 times a day (second-line therapy), as the likelihood of a decrease in the effectiveness of both antibiotics and the basic drug (s) increases. Taking into account the number of drugs used by patients during the day and necessary to obtain an eradication effect, i.e., the destruction of Helicobacter pylori (HP), in the case of additional prescription of antacid drugs, the number of tablet forms of drugs will exceed the indicated number of drug intakes (taking into account dosages), more than 6 and 13 times a day in first and second line therapy, respectively.

In peptic ulcer disease not associated with HP, antacids can be successfully used as an independent therapy for newly diagnosed, uncomplicated duodenal ulcer (with small ulcers), as well as as an additional therapy for gastric and duodenal ulcers to H 2-blockers of histamine receptors, or in therapy on demand for them or proton pump inhibitors. The success of treatment of patients largely depends on the depth of the ulcer.

When comparing the results of a 4-week treatment of 2 groups of patients suffering from uncomplicated duodenal ulcer (one of the groups was treated with various antacids in a "liquid" form or in the form of tablets, 4-6 times a day, with different neutralizing ability - from 120 to 595 mEq of H + anions per day, another group of patients was treated in therapeutic doses of H 2 -blockers of histamine receptors), no significant differences were observed in the timing of the disappearance of clinical symptoms and healing of ulcers. In another study, a comparison of the results of treatment of 42 patients treated with phosphalugel 11 g of aluminum phosphate gel 3 times a day (after meals) for 4 weeks, and treatment of 49 patients treated with ranitidine 150 mg 2 times a day also for 4 weeks showed the following: healing of duodenal ulcers was observed in 60 and 55% of cases, respectively. According to another study, based on an analysis of the results of a 6-week treatment of 153 patients who received aluminum phosphate (1 sachet = 11 g of gel) 5 times a day, healing of ulcers was found in 65% of cases.

Depending on the stage of the course in the treatment of GERD, antacids can be effectively used in the following cases: as the main drug in some patients with endoscopically negative GERD and GERD in the stage of mild reflux esophagitis (with minimally severe symptoms); in combination with H 2 blockers of histamine receptors in the course treatment of patients with GERD in the stage of mild or moderate reflux esophagitis, as well as during on-demand therapy; in course treatment of patients with GERD in the stage of erosive reflux esophagitis in combination with H 2 -blockers of histamine receptors, in on-demand therapy in combination with constant treatment of patients with proton pump inhibitors (during an exacerbation of the disease); in course treatment of patients with GERD in the stage of peptic ulcer of the esophagus in combination with H 2 -blockers of histamine receptors or in on-demand therapy (against the background of treatment of patients with proton pump inhibitors).

To improve the condition of patients, antacid drugs should also be used in the treatment of patients suffering from other diseases: in particular, with erosive and ulcerative lesions of the stomach and duodenum associated with non-steroidal anti-inflammatory drugs, with erosive and ulcerative lesions of the upper gastrointestinal tract, the occurrence of which it is possible with decompensated cirrhosis of the liver, with peptic ulcer, combined with celiac disease, and with Zollinger-Ellison syndrome.

In the course of treating patients with the listed diseases, it is advisable to use antacids during course therapy in combination with H 2 -blockers of histamine receptors (in on-demand therapy and with proton pump inhibitors).

The use of antacids is useful, as observations have shown, in the treatment of patients with acute gastritis (as an additional adsorbent for various types of acute gastritis); as an additional therapy (to H 2 blockers of histamine receptors or proton pump inhibitors) for Cushing's ulcers; in the treatment of patients with peptic ulcers of gastroenteroanastomosis and patients with chronic pancreatitis. Antacids are used in combination with H2-histamine receptor blockers or proton pump inhibitors as on-demand therapy.

Antacids should be used in the treatment of patients with functional bowel disease to relieve pain and/or discomfort. It was shown that one dose of aluminum phosphate gel with a volume of 100 to 300 ml, administered per os, just before taking a dose of radiostrontium 85Sr, reduced the absorption of the latter by 87.5%, while a dose of 100 ml of aluminum phosphate gel was as effective as 300 ml, which indicates other possibilities for the use of antacids.

It is known that aluminum phosphate gel, which is a combination of an antacid and substances that cover and protect the mucous membrane from the pathological effects of acid and bile acids, helps to eliminate (reduce) their "irritating" (pathological) effect on the mucous membrane of the esophagus and stomach, which allows us to recommend a short-term the use of this drug in pregnant women or during lactation after childbirth. The same advantages of phosphalugel (cytoprotective effect of the drug) protect the mucous membrane from damage and from the effects of alcohol.

As a symptomatic (additional) remedy for eliminating (reducing the intensity) of symptoms of dyspepsia, antacids can also be used in the treatment of patients with organic dyspepsia of various etiologies (for example, before surgical treatment of patients, if necessary, and after it), as well as to eliminate symptoms of discomfort in people who consider themselves healthy.

Features of the appointment of antacids

When prescribing antacids, it is necessary to take into account the mechanism (s) of their action and the symptoms of diseases observed in specific patients (constipation, diarrhea, etc.). In particular, in the presence of diarrhea (as an additional remedy, if necessary), it is advisable to treat patients with antacids containing aluminum (almagel, phosphalugel, rutacid, talcid); with constipation - antacids, which include magnesium (gelusil varnish, gastal, etc.).

It is known that antacids (when ingested by patients) have an adsorbing ability, due to this, it is possible to reduce the activity and bioavailability of certain medications taken by patients (for example, H 2 -blockers of histamine receptors, non-steroidal anti-inflammatory drugs, antibiotics, etc.) . Therefore, when prescribing antacids in combination with other drugs, it is advisable to recommend that patients observe the time interval between taking antacids and other drugs (before or after, about 2-2.5 hours), i.e. indicate the time the patients take specific drugs during the day .

According to our observations, the effect of taking antacids produced in the form of gels or suspensions (compared to tablet forms) occurs faster, although the tablet form seems to be somewhat more convenient for storage (especially when traveling).

When deciding on the use of antacids, especially long-term (in high dosages), it is necessary to take into account the possibility of side effects. Side effects that are possible in some patients while taking antacids, largely depend on the individual characteristics of patients, dosages of antacids and the duration of their use. Constipation or diarrhea (depending on the antacid used in the treatment of patients) are the most common side effects that occur in patients while taking antacids. A significant increase in dosages of antacids is the main cause of constipation or diarrhea, and prolonged, uncontrolled use is the appearance of metabolic disorders.

In particular, one of the features of the action of antacid preparations containing magnesium is an increase in the motor function of the intestine, which can lead to normalization of the stool, but if taken in excess, to the development of diarrhea. An overdose of magnesium-containing antacids (an increase in Mg +++ ions in the patient's body) contributes to an increase in the magnesium content in the patient's body, which can cause bradycardia and / or kidney failure.

Antacids containing calcium, in case of overdose, cause an increase in Ca ++ in the body of patients (the occurrence of hypercalcemia), which can lead to the emergence of the so-called "alkaline" syndrome in patients suffering from urolithiasis, which, in turn, contributes to increased formation of calculi. A decrease in the production of parathyroid hormone can lead to a delay in the excretion of phosphorus, an increase in the content of insoluble calcium phosphate and, consequently, to calcification of the tissues of the patient's body and the occurrence of nephrocalcinosis.

The level of aluminum absorption may be different for different drugs, which must be taken into account when determining the possible risk of side effects due to the fact that antacids containing aluminum in some patients, especially with prolonged use, can cause hypophosphatemia, with renal failure - encephalopathy, osteomalacia (with an aluminum level of more than 3.7 µmol/l), clinical symptoms considered characteristic of poisoning (with an aluminum concentration of more than 7.4 µmol/l). It is also necessary to take into account the fact that the lower toxicity of aluminum phosphate A1PO4, compared with aluminum hydroxide A1(OH)3, is due to its greater resistance to dissolution and the formation of neutral complexes in the presence of acids usually found in food, which indicates a lower toxicity of phosphate aluminum.

As a rule, the appearance of side effects can be avoided if the mechanism of their action, the condition of specific patients is taken into account when prescribing antacids, and, in addition, if detailed explanatory work is carried out with patients before prescribing antacids.

For literature inquiries, please contact the editor.

Yu. V. Vasiliev,doctor of medical sciences, professor

Central Research Institute of Gastroenterology, Moscow

People often use antacids for heartburn, nausea, or stomach discomfort. Patients with diseases of the digestive system, they are also necessary. Drugs envelop the stomach, protecting it. You can buy them without a prescription from a doctor. The choice of funds is quite wide, read a detailed review in our material.

Enveloping preparations are plant-based and synthetic. The substances that make up antacids create a protective barrier on the gastric mucosa, neutralize hydrochloric acid. This gives the effect of protection and pain relief. Some of the drugs have antimicrobial and anti-inflammatory effects. If acidity is increased, the stomach is subject to other irritating factors (stress, poor nutrition), then these medications are indicated.

Antacids today are produced in different forms, so everyone can find the one that is convenient for him: tablets, powders, suspensions in bottles or single packs.

Indications for use

Antacids are needed for diseases of the gastrointestinal tract. The composition contains components that react with water, while forming substances that envelop the stomach. This is what makes these drugs so popular.

Enveloping agents are indicated for:

acute gastritis;
chronic gastritis;
stomach ulcer and duodenal ulcer;
heartburn;
inflammation of the pancreas;
reflux esophagitis;
with inflammation of the gallbladder;
enteritis;
colitis;
one-time violation of the diet;
toxicosis of pregnant women;
burns.

It is noteworthy that antacids can be used not only for gastritis and ulcers, but also externally (for burns and other skin lesions).

Effect

Medicines do the following:

envelop the stomach, protecting it;
stop nausea and vomiting;
eliminate pain;
neutralize excess hydrochloric acid;
prevent reflux (reflux of bile from the duodenum into the stomach);
fight diarrhea.

Pharmacies offer a wide range of medicines. To help you decide, consider the most popular drugs.

Things to Remember

Continuous use of antacids without a doctor's prescription can adversely affect health.
If you often have to resort to such drugs for nausea, heartburn or epigastric pain, do not put off a visit to the doctor for diagnosis and treatment. Such symptoms signal the presence of a gastrointestinal disease. If they are ignored, the disease will worsen and it will be much more difficult to cure it.
For ulcers, gastritis and other pathologies of the stomach and intestines, antacids are used as part of complex therapy (more to neutralize the unpleasant symptoms of the disease).
Caution should be taken with enveloping preparations for children and pregnant women. Some of them are contraindicated for these categories of persons. Before use, consult your doctor.

What are

Any medicine tends to be absorbed or not absorbed into the stomach.

Absorbable

If the components of the drug interact with hydrochloric acid, then they partially penetrate into the blood. The benefits of using such medications include the rapid elimination of heartburn. But the effect is short-lived.

Such drugs are characterized by the so-called "acid rebound": antacids react with hydrochloric acid, as a result, carbon dioxide is released. The stomach stretches, and hydrochloric acid begins to produce with renewed vigor, heartburn appears again. In addition, these drugs are adsorbed in the intestines, causing the formation of edema. Side effects are also increased pressure, belching and bloating. Such products include, for example, soda.

active substances These drugs may include:

magnesium oxide;
sodium bicarbonate;
magnesium and calcium carbonate.

This group of drugs:

Vikalin;
Vikair;
Rennie;
Bourget mix;
Tums;
magnesia.

Antacids from this group are intended for single or rare use, as otherwise they can cause the progression of gastrointestinal diseases (for example, stomach and duodenal ulcers).

Non-absorbable

Non-absorbable antacid drugs are most effective and have fewer side effects.

Non-absorbable drugs neutralize hydrochloric acid, bile and pepsin. When they enter the stomach, they envelop it and protect it from irritating factors. The therapeutic effect occurs within 15 minutes and lasts up to 4 hours.

Different enveloping agents have their own mechanism of action, based on the composition:

Medications that envelop through aluminum phosphates. The most popular remedy from this group is Phosphalugel. Its action depends on the initial level of acidity. The higher it is, the more effective the medicine.
Antacids containing magnesium and aluminum. Almagel is one of them.
Combination medicines. In this case, there can be 2 variations: aluminum + magnesium + silicon and sodium + calcium. Such drugs create a mechanical barrier that prevents gastric juice from entering the esophagus.

The following non-absorbable enveloping agents for the stomach and intestines:

almagel;
phosphalugel;
maalox;
Altacid;
sucralfate;
gastracid;
gastal;
relzer;
alumag;
gaviscon;
palmagel;
rutacid;
magalfil.

Before purchasing a medicine, carefully read the instructions for use and contraindications. Some drugs have additional effects (for example, Almagel A - analgesic). It is strictly forbidden to take such funds without a doctor's prescription for a long time.

Almagel

Almagel is an antacid agent that neutralizes the secretion of enzymatic juice in the stomach. Under its influence, hydrochloric acid is produced less, and the level of pepsin is normalized. Among the shortcomings - the drug removes phosphorus, therefore it is not recommended for long-term use for people with problems of bones and joints.

Almagel is produced in the form of a suspension, which greatly facilitates the application and accelerates the effect. Shown at:

gastritis;
ulcers;
esophagitis;
increased level of acidity;
bloating;
pain;
enteritis;
poisoning;
nausea;
heartburn.

When taking anti-inflammatory or glucocorticoid drugs, Almagel should be used to prevent ulcers. Reception lasts no more than 2 weeks, you need to drink the drug 5-10 g before meals.

The defoamer has an adsorbing and enveloping effect. The drug acts for a long time, normalizes acidity and does not contribute to gas formation.

Phosphalugel

Phosphalugel is an antacid substance that envelops the walls of the stomach and has an adsorbing effect. The medicine is indicated for:

gastritis and ulcers;
gastroesophageal reflux;
syndrome of non-ulcerative dyspepsia;
intestinal disorder;
functional bowel diseases;
diarrhea.

Antacid medicine should not be used for serious kidney disease and individual intolerance to the components.

Adults and children under the age of 6 years are prescribed a medicine for 1-2 packets 2-3 times a day. Babies up to 6 months - 1 tsp. Children from 6 months - ½ sachet.

Take the drug before or after meals should be as follows:

with reflux and hernia - after meals and at night;
with an ulcer - 1-2 hours after a meal;
with gastritis and dyspepsia - before meals;
with bowel diseases - on an empty stomach and 1 time at night.

If pain occurs, you can resume taking.

The suspension quickly neutralizes hydrochloric acid, while maintaining the digestion process.

Maalox

Maalox is sold as a suspension. The antacid contains peppermint leaf oil. Among the shortcomings - it reduces the absorption of phosphorus, therefore it is not recommended for the elderly and patients with joint problems.

Shown at:

exacerbation of an ulcer;
acute or chronic gastritis;
hiatal hernia;
reflux esophagitis;
heartburn;
pain in the epigastrium.

Antacids are not prescribed for:

renal failure;
individual allergy to the components;
fructose intolerance;
in childhood and adolescence up to 15 years;
hypophosphatemia.

The medicine is taken in 15 ml. one hour after eating. If you experience pain, you can use 1 sachet. But it should be noted that the maximum dose per day is 90 ml.

Depending on the disease, determine the dosage:

with reflux esophagitis, 30-60 ml are used. after meal;
with an ulcer - 15 ml. half an hour before meals.

Treatment should not exceed 2-3 months.

The following side effects may occur:

hypersensitivity to components;
allergy;
rarely - constipation, diarrhea;
hypermagnesemia (increased magnesium levels).

The drug stays in the stomach for a long time, has a long-term protective effect.

Gaviscon

This drug has very few contraindications, has a beneficial effect on the cells of the esophagus, can be used during pregnancy, and has a protective effect. The effect appears after a few minutes and lasts about 4 hours.

Indications:

heartburn;
belching;
dyspepsia;
gastroesophageal reflux;
toxicosis of pregnant women.

Contraindications:

individual intolerance;
age up to 12 years;
phenylketonuria.

It is taken up to 4 times a day, 2-4 tablets after meals and at bedtime, up to 7 days.

Gaviscon, according to the Romir Research Center, is the best drug for heartburn, named by the majority of gastroenterologists surveyed.

Sucralfate

Sucralfate refers to drugs that have an enveloping effect. Pharmacology is as follows: under its influence, the production of pepsin slows down, and the acid in the stomach binds. The antacid lasts for 6 hours. The medicine is indicated for:

heartburn;
ulcers;
erosive and ulcerative lesions of the gastrointestinal tract;
reflux esophagitis.

The medicine is contraindicated in:

kidney disease;
dysphagia;
internal bleeding of the gastrointestinal tract;
allergies to components.

List of side effects:

indigestion;
constipation;
gas formation;
drowsiness;

Adults are prescribed up to 1 g per day. The dose must be divided into 4 doses. The maximum allowed to use up to 12 g per day. The course lasts up to 6 weeks. In especially severe cases - 3 months.

Keep in mind that antacids are sold by prescription from a doctor.

natural antacids

It is not always necessary to use medical drugs. With prolonged use or less pronounced symptoms, we advise you to pay attention to natural antacids.

The easiest and cheapest way to deal with heartburn is to drink warm water (preferably mineral water)
Bananas soothe stomach pains, fight the symptoms of heartburn.
Usage potato or corn starch has a protective effect on the gastric mucosa. It practically does not dissolve in cold water, but in warm water it turns into an enveloping mixture. You can also eat starchy vegetables.
Clove oil perfectly envelops the walls of the stomach and esophagus (2-3 drops per glass of water). It is also recommended to use ground cloves as a condiment to combat heartburn.
Cinnamon is a wonderful natural antiseptic and antacid.
Herbal tea made from mint, lavender and anise (if desired with the addition of honey) will perfectly cope with a burning sensation in the sternum.
Dill seeds in the amount of ½ tsp. after eating will help to cope with heartburn and discomfort in the stomach.
Flax seed is often used to prevent ulcers and gastritis. It is used as a mucus solution. For cooking you need: 1 tsp. crushed seeds for ½ tbsp. water. Consume warm 30 minutes before meals. The tool envelops the walls of the stomach, protecting it.
grapefruit peel, chewed with heartburn, will help to cope with unpleasant symptoms.
1 st. l. crushed walnuts 1 time per day - a good prevention of heartburn.
Freshly squeezed potato juice taken before meals 2 tbsp. l. - also a wonderful tool.

Enveloping drugs have a positive effect on the gastrointestinal tract and irritating factors no longer bring negative consequences. The funds have been tested, as a result of which a beneficial effect has been proven for people suffering from frequent heartburn, gastritis and ulcers. Before choosing a medication for yourself, you should consult a doctor, as there are contraindications for use. And also you need to individually select the dosage.

This group includes agents that neutralize hydrochloric acid and reduce the acidity of gastric juice. These are anti-acid drugs. Usually these are chemical compounds with the properties of weak bases, they neutralize hydrochloric acid in the lumen of the stomach. The decrease in acidity is of great therapeutic importance, since the activity of pepsin and its digestive effect on the gastric mucosa depend on its amount. The optimum pH value for pepsin activity is in the range from 1.5 to 4.0. At pH=5.0, pepsin is inactive.

Therefore, it is desirable that antacids raise the pH no higher than 4.0 (optimally, when taking antacids, the pH of gastric juice should be 3.0-3.5), which does not disturb the digestion of food. Usually, the pH of gastric contents normally ranges from 1.5 to 2.0. The pain syndrome begins to subside when the pH becomes more than 2. In this sense, the role of antacids is twofold.

There are systemic and non-systemic antacids. Systemic antacids are agents that can be absorbed, and therefore not only give effects in the stomach, but can also lead to the development of alkalosis in the body as a whole. Non-systemic antacids are not absorbed, and therefore are able to neutralize acidity only in the stomach, without affecting the acid-base state of the body.

Antacids include SODIUM HYDROCARBONATE (drinking soda), CALCIUM CARBONATE, ALUMINUM and MAGNESIUM HYDROOXIDE, magnesium oxide. Usually these substances are used in different dosage forms and in different combinations.

Systemic antacids include sodium bicarbonate and sodium citrate, while the rest of the above agents are non-systemic.

Sodium bicarbonate (drinking soda) is a compound that is highly soluble in water, quickly reacting in the stomach with hydrochloric acid. The reaction proceeds with the formation of sodium chloride, water and carbon dioxide. The drug works almost instantly. Although sodium carbonate acts quickly, its effect is short and weaker than that of other antacids. The carbon dioxide formed during the reaction stretches the stomach, causing bloating and belching. In addition, taking this drug may be accompanied by a "recoil" syndrome. The latter is that a rapid increase in gastric pH leads to the activation of parietal G-cells in the central part of the stomach, producing gastrin.

Gastrin also stimulates the secretion of hydrochloric acid, which leads to the development of hyperacidity after the cessation of the antacid. Usually the syndrome of "recoil" develops in 20-25 minutes.

Due to good absorption from the gastrointestinal tract, sodium bicarbonate can cause systemic alkalosis, which will be clinically manifested by decreased appetite, nausea, vomiting, weakness, abdominal pain, muscle cramps and cramps. This is a rather dangerous complication requiring immediate discontinuation of the drug and assistance to the patient. Due to the severity of these side effects, sodium bicarbonate is rarely used as an antacid.

Non-systemic antacids, as a rule, are insoluble, act in the stomach for a long time, are not absorbed, and are more effective. With their use, the body does not lose either cations (hydrogen) or anions (chlorine), and there are no changes in the acid-base state. The action of non-systemic antacids develops more slowly, but it is longer.

First of all it should be mentioned:

1) aluminum hydroxide;

2) magnesium oxide.

ALUMINUM HYDROOXIDE (aluminum hydroxide; Aluminii hydroxydum) - a drug with a moderate antacid effect, acts quickly and effectively, shows a significant effect after about 60 minutes.

The drug binds pepsin, reduces its activity, inhibits the formation of pepsinogen and increases the separation of mucus.

One gram of aluminum hydroxide neutralizes 250 ml of decinormal hydrochloric acid to pH = 4.0.

In addition, the drug has astringent, enveloping and adsorbing effects.

Side effects: not all patients tolerate the astringent effect of the drug well, which may manifest as nausea; taking aluminum preparations is accompanied by constipation, therefore, aluminum-containing preparations are combined with magnesium preparations. Aluminum hydroxide promotes the excretion of phosphates from the body.

The drug is indicated for diseases with increased secretion of gastric juice (hydrochloric acid): ulcers, gastritis, gastroduodenitis, food poisoning, flatulence. Assign aluminum hydroxide inside in the form of a 4% aqueous suspension of 1-2 teaspoons per reception (4-6 times a day).

Magnesium oxide (Magnesii oxydum; powder, gel, suspension) burnt magnesia is a strong antacid agent, more active than aluminum hydroxide, acts faster, lasts longer and has a laxative effect.

Each of the listed antacids has a certain range of advantages and disadvantages. In this regard, their combinations are used.

The combination of aluminum hydroxide in the form of a special balanced gel, magnesium oxide and D-sorbitol made it possible to obtain one of the most common and effective, at present, antacid drugs - Almagel (Almagel; 170 ml; the drug got its name from the words al-aluminum, ma-magnesium , gel-gel). The drug has an antacid, adsorbing and enveloping effect. The gel-like dosage form contributes to the uniform distribution of the ingredients over the surface of the mucous membrane and the prolongation of the effect. D-sorbitol promotes bile secretion and relaxation.

Indications for use: gastric and duodenal ulcer, acute and chronic hyperacid gastritis, gastroduodenitis, esophagitis, reflux esophagitis, Zollinger-Ellison syndrome, pregnancy heartburn, colitis, flatulence, etc.

There is a drug Almagel-A, in which, in addition to the composition of Almagel, an anesthetic is also added, which has both a local anesthetic effect and suppresses gastrin secretion.

Almagel is usually used 30-60 minutes before a meal, and also within an hour after a meal. The drug is prescribed individually, depending on the localization of the process, the acidity of gastric juice, etc.

Drugs similar to Almagel:

Gastrogel (Czechoslovakia);

Phosphalugel (Yugoslavia) contains aluminum phosphate and colloidal gels of pectin and agar-agar, which bind and absorb toxins and gases, as well as bacteria, reduce the activity of pepsin;

Megalac (Germany);

Mylanta (USA) contains aluminum hydroxide, magnesium oxide and simethicone;

Gastal (Yugoslavia) - tablets, which include: 450 mg of aluminum hydroxide - magnesium carbonate gel, 300 mg of magnesium hydroxide.

Currently, the most popular drug from the group of antacids in many countries of the globe is the drug MAALOX (Maalox) by the French company Rhone-Poulenc Rorer. The composition of the drug includes aluminum hydroxide and magnesium oxide. Maalox is available as a suspension and tablets; 5 ml suspension of Maalox contains 225 mg of aluminum hydroxide, 200 mg of magnesium oxide and neutralizes 13.5 mmol of hydrochloric acid; the tablets contain 400 mg of aluminum hydroxide and magnesium oxide, so they have a higher acid-neutralizing activity (up to 18 mmol of hydrochloric acid). Maalox-70 is even more active (up to 35 mmol of hydrochloric acid).

The drug is indicated for gastritis, duodenitis, peptic ulcer of the stomach and duodenum, reflux esophagitis.

There are practically no side effects. MEGALAC (Megalac) is a German drug, an analgesic antacid (silicic aqueous aluminum-magnesium). It contains 0.2 aluminum oxide, 0.3 magnesium oxide and 0.02 oxetaine.

Topalkan is a French antacid drug. It consists of alginic acid, colloidal aluminum hydroxide, magnesium bicarbonate, hydrated silicon in a precipitated shapeless state. The drug has a foaming effect, forms a gel on the surface of the liquid contents of the stomach, covers the mucous membrane; acts quickly (6-14 minutes) and long-term (2-4 hours). Beneficial for esophagitis, reflux esophagitis.

MEDICINES PROTECTING THE GASTRIC MUCOSA FROM ACID-PEPTIC IMPACT AND IMPROVING REPARATIVE PROCESSES

1. Bismuth preparations (vikalin, vikair, de-nol).

2. Venter.

3. Preparations of prostaglandins.

4. Dalargin.

Bismuth preparations are used as astringents and antiseptics in the treatment of patients with peptic ulcer. Most often, these are combined tablets - VIKALIN (basic bismuth nitrate, sodium bicarbonate, calamus rhizome powder, buckthorn bark, rutin and kellin). Related drug VIKAIR (no rutin and kellin).

In recent years, medical practice has included drugs that more powerfully protect the mucosa from acid-peptic effects. These are colloidal preparations of bismuth of the second generation, one of which is DE-NOL (De-nol; 3-potassium dicitrate bismuthate; each tablet contains 120 mg of colloidal bismuth subcitrate). This drug envelops the mucous membrane, forming a protective colloid-protein layer on it. They do not have an antacid effect, but exhibit antipeptic activity by binding pepsin. The drug also has an antimicrobial effect, it is much more effective than bismuth-containing antacids, increases the resistance of the mucosa. De-nol cannot be combined with antacids.

The drug is used for any localization of the ulcer, it is highly effective in:

ü long-term non-scarring ulcers of the stomach and duodenum;

peptic ulcer in smokers;

prevention of recurrence of peptic ulcer;

ü chronic gastritis.

Assign 1 tablet three times a day half an hour before meals and 1 tablet at bedtime. De-nol is contraindicated in severe renal failure.

VENTER (sukrat; in tab. 0.5 each) is a basic aluminum salt of sucrose octasulfate. Antiulcer action is based on binding to dead tissue proteins into complex complexes that form a strong barrier. Gastric juice is locally neutralized, the action of pepsin slows down, the drug also absorbs bile acids. At the site of the ulcer, the drug is fixed for six hours.

Venter and de-nol cause scarring of duodenal ulcers in three weeks.

Sukrat is used 1.0 four times a day before meals, and also at bedtime.

Side effect: constipation, dry mouth.

Drugs that improve trophism, regeneration and mucus formation.

Among the "reparants" there are many preparations of plant origin, there are biological preparations and artificially synthesized ones.

The following drugs are most often used in the practice of gastroenterology:

I generation:

Sodium oxyferricarbon;

Gefornil;

Gastrofarm.

Sodium oxyferriscarbon contains bi- and trivalent iron in combination with sodium salts of various acids (gulonic and alloxonic).

The drug has a regenerating, anti-inflammatory and analgesic effect. Effective for stomach ulcers. With peptic ulcer of the duodenum, the drug is ineffective.

Oxyferricarbon sodium is prescribed intramuscularly at 30-60 mg for 10-20 days, the course is repeated 2-3 times.

SOLCOSERYL (Solcoseryl) - protein-free extract from the blood of cattle. Protects tissues from hypoxia and necrosis. It is used for trophic ulcers of any localization.

Apply 2 ml 2-3 times a day, intravenously and intramuscularly, until the ulcer heals.

Prostaglandin preparations:

Mizoprostol (saytotec), etc. Under the action of these drugs, the acidity of gastric juice decreases, the motility of the stomach and intestines increases, and favorable effects on the ulcerative niche in the stomach are noted.

The drugs also have a reparative, hypoacid (by increasing mucus formation), hypotensive effect.

Misoprostol (Misoprostol; in tab. 0.0002) is a preparation of prostaglandin E-2, obtained from plant materials.

Synonym - SYTOTECH.

Prostaglandin preparations are indicated for acute and chronic gastric and duodenal ulcers.

Side effects: transient diarrhea, mild nausea, headache, abdominal pain.

Assign one tablet twice a day. The combination of misoprostol with NSAIDs (Voltaren) - the drug ARTROTEK - is used.

DALARGIN (Dаlarginum; in amps and vials of 0.001) is a peptide drug that promotes the healing of gastric and duodenal ulcers, reduces the acidity of gastric juice, and has a hypotensive effect.

The drug is indicated for exacerbation of peptic ulcer of the stomach and duodenum.

Contraindications to the use of dalargin are hypotension and pregnancy.

MEDICINES WITH SPECIFIC ANTIBACTERIAL EFFECT ON Helicobacter pylory

(De-nol, metronidazole, oxacillin, furazolidone) The drug metronidazole has a wide spectrum of action against protozoa (Trichomonas, amoeba, Giardia), acts on anaerobic microflora (for diseases of the chest organs, urinary tract), as well as on Helicobacter pylory. The most effective antibacterial effect is observed with a combination of metronidazole and de-nol.

DRUGS AFFECTING INTESTINAL MOTORITY