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1 Gastro-intestinal system
1.1
Dyspepsia and gastro-oeso-
phageal reflux disease
43
1.1.1
Antacids and simeticone
44
1.1.2
Compound alginates and pro-
prietary indigestion preparations
46
1.2
Antispasmodics and other drugs
altering gut motility
47
1.3
Antisecretory drugs and mucosal
protectants
49
1.3.1
H
2
-receptor antagonists
51
1.3.2
Selective antimuscarinics
53
1.3.3
Chelates and complexes
53
1.3.4
Prostaglandin analogues
54
1.3.5
Proton pump inhibitors
54
1.4
Acute diarrhoea
57
1.4.1
Adsorbents and bulk-forming
drugs
58
1.4.2
Antimotility drugs
58
1.5
Chronic bowel disorders
59
1.5.1
Aminosalicylates
61
1.5.2
Corticosteroids
64
1.5.3
Drugs affecting the immune
response
65
1.5.4
Food allergy
66
1.6
Laxatives
67
1.6.1
Bulk-forming laxatives
67
1.6.2
Stimulant laxatives
68
1.6.3
Faecal softeners
70
1.6.4
Osmotic laxatives
71
1.6.5
Bowel cleansing preparations
73
1.6.6
Peripheral opioid-receptor
antagonists
74
1.6.7
5HT
4
-receptor agonists
75
1.7
Local preparations for anal and
rectal disorders
75
1.7.1
Soothing haemorrhoidal pre-
parations
75
1.7.2
Compound haemorrhoidal pre-
parations with corticosteroids
76
1.7.3
Rectal sclerosants
77
1.7.4
Management of anal fissures
77
1.8
Stoma care
77
1.9
Drugs affecting intestinal secre-
tions
78
1.9.1
Drugs affecting biliary composi-
tion and flow
78
1.9.2
Bile acid sequestrants
78
1.9.3
Aprotinin
79
1.9.4
Pancreatin
79
This chapter also includes advice on the drug man-
agement of the following:
Clostridium difficile
infection,
p.
60
constipation,
p.
67
Crohn’s disease,
p.
59
diverticular disease,
p.
61
food allergy,
p.
66
Helicobacter pylori
infection, p.
49
irritable bowel syndrome,
p.
61
NSAID-associated ulcers, p.
50
ulcerative colitis,
p.
59
1.1
Dyspepsia and gastro-
oesophageal reflux
disease
1.1.1 Antacids and simeticone
1.1.2 Compound alginates and proprietary
indigestion preparations
Dyspepsia
Dyspepsia covers upper abdominal pain,
fullness,
early
satiety,
bloating,
and nausea.
It can occur with gastric
and duodenal ulceration (section 1.3) and gastric cancer
but most commonly it is of uncertain origin.
Urgent endoscopic investigation is required if dyspepsia
is accompanied by ‘alarm features’
(e.g.
bleeding,
dys-
phagia,
recurrent
vomiting,
or
weight
loss).
Urgent
investigation should also be considered for
patients
over 55 years with unexplained, recent-onset dyspepsia
that has not responded to treatment.
Patients with dyspepsia should be advised about
life-
style changes (see Gastro-oesophageal
reflux disease,
below). Some medications may cause dyspepsia—these
should be stopped,
if
possible.
Antacids may provide
some symptomatic relief.
If symptoms persist in
uninvestigated dyspepsia
,
treat-
ment involves a proton pump inhibitor (section 1.3.5)
for
4 weeks.
A proton pump inhibitor
can be used
intermittently to control
symptoms long term.
Patients
with uninvestigated dyspepsia,
who do not respond to
an initial
trial
with a proton pump inhibitor,
should be
tested for
Helicobacter
pylori
and given eradication
therapy (section 1.3)
if
H.
pylori
is present.
Alterna-
tively, particularly in populations where
H. pylori
infec-
tion is more likely,
the ‘test
and treat’
strategy for
H.
pylori
can be used before a trial
with a proton pump
inhibitor.
BNF 61
43
1
Gastro-intestinal system