Diseases associated with the gastrointestinal tract occur in many people and are considered the most common among all other organ diseases. Statistics say that 90% of citizens need constant consultation with a specialist, as they experience regular stomach problems.
Among the main symptoms indicating pathology of the digestive system, pain in the abdominal area of varying intensity, nausea, constipation, heartburn, vomiting, poor appetite, and sudden weight loss are most often observed.
The main reasons for the development of stomach diseases include poor nutrition, bad habits, excess weight, infectious diseases, and diabetes.
Prevention of gastrointestinal tract
Few people would like to suffer from unpleasant symptoms all the time, undergo painful examinations, take a bunch of medications and give up their favorite treats. You shouldn’t risk your health; it’s better to make adjustments to some aspects of life in advance than to suffer from chronic diseases later. Following simple preventive measures will help you avoid many health problems, regardless of age.
A set of preventive measures:
- proper nutrition. Before eating, be sure to wash your hands to prevent infections. Frequent meals consisting of several small portions will be beneficial. It is undesirable to skip meals, especially when it comes to breakfast;
- diet. It would be a good idea to reduce your consumption of smoked, fatty and fried foods. Dishes should not contain a lot of salt. You need to eat more fruits and vegetables, cereals, and fresh salads. When preparing food, you should limit the amount of vinegar and hot spices;
- Avoid snacking on the go. Lack of fluid in the body often causes constipation and provokes the appearance of thick bile. A person should consume at least 1.5 liters of liquid per day;
- don't overeat. You need to eat in moderation; the standard serving size is 350 ml. However, fasting is also harmful, so you should eat in an orderly manner. Regular eating at a certain time will help synchronize the motor activity of organs, normalize the secretion of digestive juices;
- to refuse from bad habits. Nicotine in any quantity negatively affects the digestive system, so you need to avoid it completely. Alcohol intake should be kept to a minimum. Low-quality products include various chemical elements, dyes, flavors, which as a result have a detrimental effect on the gastrointestinal tract;
- take more fermented milk products. Cottage cheese, kefir, yogurt, sour cream help improve the antitoxic ability of the liver, intestinal motility, and suppress putrefactive processes in the intestine;
- reduce consumption of coffee and carbonated drinks. The permissible amount of coffee per day is 350 ml in finished form. If you cannot completely eliminate carbonated drinks from your diet, it is advisable to drink no more than 250 ml per day.
It is also worth moving more, spending a lot of time in the fresh air, taking medications with caution, visiting doctors in a timely manner, and avoiding stressful situations.
How to deal with constipation
One of the most common bowel disorders is constipation. It can occur in people of all ages and cause discomfort. The consequence is usually insufficient fluid intake, medications, stressful situations, and lack of physical activity.
To eliminate unpleasant symptoms, you will have to reconsider all the factors and find methods to eliminate them.
Is there enough fluid in the daily diet?
Initially, you should pay attention to your diet. To eliminate constant constipation, you should drink at least 7 glasses of liquid a day, which can be any kind; it is better to give preference to plain water.
Medicines
Uncontrolled use of medications can lead to serious problems. There are a large number of medications that can cause constipation. The most common are antacids, which include calcium and aluminum, antihistamines, narcotic drugs, antidepressants, and diuretics.
Proven remedies include Duspatalin.
Stressful situations
Most digestive ailments are directly related to mental comfort. Regular stress, psychological discomfort, family conflicts, problems at work negatively affect the functioning of the gastrointestinal tract. You shouldn’t get depressed and worry all the time with or without reason. Hearty laughter has a positive effect on constipation. It massages the intestines, which has a beneficial effect on digestion, and laughter also helps get rid of a bad mood.
Physical activity
Physical activity has a beneficial effect not only on the heart, but also on intestinal function. Regular exercise will help relieve constipation, as food will move through the intestines faster.
Drug-induced gastrointestinal lesions
Lecture transcript
XXVI All-Russian Educational Internet Session for doctors
Total duration: 20:15
00:00
Oksana Mikhailovna Drapkina, executive director of the Internet Session, secretary of the interdepartmental council on therapy of the Russian Academy of Medical Sciences:
— Our next performance is in this section. Professor Karateev Andrey Evgenievich. "Drug-induced damage to the gastrointestinal tract (GIT)."
Andrey Evgenievich Karateev, professor:
— Thank you very much, Oksana Mikhailovna, for giving the floor.
Unfortunately, due to lack of time, we cannot adequately fully cover the problem of drug complications affecting the gastrointestinal tract. At the end of the 20th – beginning of the 21st century, we were faced with the problem that doctors should fight not with some external factors, but with what civilization itself produces. What we did to improve our quality of life, and to improve the life of modern society as a whole, suddenly turns into a certain harm.
Unfortunately, we understand that the population is aging. There are more and more people suffering from chronic diseases. This means that there are more and more people who are receiving active (even aggressive) drug therapy. It's unavoidable.
One class of drugs that is increasingly used in clinical practice are nonsteroidal anti-inflammatory drugs. This is the most popular class of analgesics worldwide and is used to relieve acute and chronic pain. Today it occupies an unshakable position among drugs used to improve the quality of life of patients with chronic rheumatic diseases.
According to statistics for 2007, in Russia, with a population of 140 million inhabitants, 105 million packages of NSAIDs and 11 million packages of CardioAspirin were sold. This is a huge amount of drugs. Unfortunately, this is a problem that we are facing more and more often. The downside to the effectiveness of NSAIDs and their ease of use is the risk of complications, primarily from the gastrointestinal tract.
According to statistics, if we take a group of patients who take, for example, the good old Diclofenac every day for a year, then one in two hundred patients will develop gastrointestinal bleeding. Approximately 10% of patients develop gastric and duodenal ulcers.
NSAIDs can cause serious complications in the esophagus (exacerbation of GERD and the appearance of its complicated forms). The most common complication we see with the use of NSAIDs is not severe complications, but dyspepsia. This is a complex of unpleasant sensations that accompany taking NSAIDs. It develops in every third patient who regularly uses them, and in every 10th patient it causes interruption of therapy.
02:43
According to a survey of 3,000 respondents in six regions of Russia (which we conducted not so long ago, five years ago), bleeding is approximately 1.5% (its frequency). An ulcer is detected in approximately 9%, dyspepsia in every third patient.
Fortunately, today we understand well that serious complications from the gastrointestinal tract are not a necessary evil. The vast majority of these complications develop in people who have serious risk factors. They can be divided into two large groups. “Changeable” is something we can influence. This is the use of high doses of NSAIDs, erroneous combined use of several drugs from this group, smoking and drinking alcohol, and Helicobacter pylori infection.
"Unchangeable" factors. They already exist, we can't do anything with them. We must plan patient management and prevent complications taking into account these factors. These are a history of ulcers, old age (the threshold is 65 years) and taking medications that increase the risk of bleeding that affects the coagulation of the blood system (low doses of Aspirin, anticoagulants and high doses of steroid hormones).
The problem is that, unfortunately, these risk factors are very common among patients who require and take adequate pain therapy and NSAIDs. According to our data, which we received during a survey in Russia, almost every 10th patient has an ulcer history in Russian patients. The prevalence of Helicobacter pylori is very high.
GERD is a very serious and common disease. Its complications are also a serious problem today. Gallstone disease is a complication burden that we must consider when prescribing NSAIDs.
The appearance of a patient who develops a gastrointestinal complication. Data from a large Dutch study. 51,000 patients, 104 bleeding episodes. Very serious complications, 10% of patients died. These are patients who receive a lot of medications. These are the patients who receive the old non-selective NSAIDs, unacceptably high doses of these drugs. These are the patients who use combination therapy. The most important thing is those patients who, in addition to NSAIDs, receive very active therapy for the treatment of cardiac diseases.
05:16
This is a very important topic because it closely leads us to the problem of cardiovascular complications associated with NSAIDs. The fact is that for a very long time the situation with NSAIDs looked like this. We thought that the main complication we had to deal with was damage to the gastrointestinal tract.
Unfortunately, everything has changed in the last 5 years. We have learned that NSAIDs are not only a risk for gastrointestinal complications, but also a risk for the development or progression of cardiac disease. First of all, we are afraid of their prothrombotic effect. NSAIDs can contribute to the development of cardiovascular accidents.
The main problem with the use of NSAIDs in the modern population is that we use them in older people. These are the people who have a very high comorbidity.
Data from one of the most interesting recent studies that assesses the risk of complications in patients who take NSAIDs. This is the Spanish study "LOGICA". What is its essence? Over one week in 2006, researchers asked Spanish rheumatologists to evaluate 10 patients with osteoarthritis who came to them and who required NSAIDs.
The distribution of risks, gastrointestinal and cardiovascular, is shown. A very significant part – 22% – had the highest risk of developing gastrointestinal complications. 44% had a very high cardiovascular risk, assessed using the SCORE index.
Most importantly, almost half of the patients who needed and took NSAIDs had a combination of both gastrointestinal and cardiovascular risks. Today, when we talk about the use of NSAIDs, we cannot focus only on the problem of gastrointestinal risks. We must also combat cardiovascular risk. This is the principled position of the entire world community.
07:11
Previously, the situation looked like this. A new group of selective CO II inhibitors was responsible for cardiovascular risk. Medicines that have been created specifically to reduce gastrointestinal risk. But it turned out that these drugs can cause serious cardiovascular complications (myocardial infarction, ischemic risk, sudden coronary death).
However, recently the situation has not changed for the better. It turned out that all NSAIDs (traditional and non-traditional) can increase the risk of cardiovascular accidents.
Data from a large population study that was published in 2010 in Denmark. More than a million residents (relatively speaking, healthy) who have not been admitted to any hospitals for exacerbation of chronic diseases for five years. Many of them had a history of being prescribed one or another NSAID.
It turned out that the most dangerous NSAIDs of all those used in this highly developed country at the beginning of the 21st century are non-selective COX II inhibitors. This is good old Diclofenac. It was he who most often caused complications such as stroke, heart attack and sudden coronary death.
Very often situations arise when a patient who needs adequate NSAID therapy is forced to receive medications that affect the coagulation of the blood system. First of all, low doses of Aspirin. This is a fundamental problem today. Even the smallest dose of Aspirin, which is used as an antiplatelet agent, can significantly increase the risk of major bleeding.
08:49
Data from the 2002 Derry, Loke meta-analysis. In total, 66,000 patients are involved. When using Aspirin in a dose of 100 mg or less, the risk of major gastrointestinal bleeding increases by more than 1.5 times. This is a very serious number.
More recently, we tried to switch to a safer antiplatelet drug - Clopidogrel/Ticlopidine. Cardiologists told us that these drugs are no less, perhaps more effective than Aspirin in terms of their antiplatelet effect. But it has a more pronounced risk of gastrointestinal complications.
Unfortunately, life has not confirmed these provisions. Data from a very large Spanish population study. It has been clearly shown that all drugs that are used to prevent vascular thrombosis (low doses of Aspirin, Ticlopidine, Clopidogrel, and oral anticoagulants such as Warfarin) increase the risk of developing major gastrointestinal tract with equal frequency. intestinal bleeding.
A typical picture seen by an endoscopist dealing with such patients. This is our 65-year-old patient, a lady with osteoarthritis. She does not receive NSAIDs, but receives Cardiomagnil for one year. You see multiple erosions in the antrum of the stomach.
On the right is a younger patient, 42 years old, with primary antiphospholipid syndrome (PAPS). She has been receiving Warfarin for a year. A similar picture. All drugs that can affect the coagulation of the blood system can cause serious complications in the gastrointestinal tract.
Of course, a simple thought arises. We must protect our patients from these types of complications. This means we must use medications that will protect the gastrointestinal tract.
Today, there is no doubt that the main class of drugs that can and should be used to prevent serious complications of the gastrointestinal tract associated with the negative effects of certain drugs are proton pump inhibitors.
But are they all suitable for use as prevention and complications associated with antiplatelet agents (medicines that affect the coagulation of the blood system). Unfortunately, drug interactions play a fundamental role in this situation.
11:05
Data from a large study carried out in Germany. It included thousands of patients with coronary artery disease who underwent coronary stenting. These patients receive the classic combination of Aspirin and Clopidogrel. They received various proton pump inhibitors. This is real clinical practice. 26%.
Unfortunately, the proton pump inhibitor Omeprazole, which is very popular in our country, very significantly changes the effectiveness of antiplatelet drugs. He lowers it. But drugs such as Esomeprazole do not have a negative effect on the combination of Clopidogrel and Aspirin.
Similar data were obtained in a study that was published in 2010. Similar design. "Rabeprazole", "Omeprazole". Patients receive Aspirin and Clopidogrel. After two weeks of taking these proton pump inhibitors, there is a clear decrease in the effectiveness of the antiplatelet effects of these drugs.
The issue of drug interactions in elderly people who receive many drugs at the same time is of fundamental importance today.
We must clearly understand what a drug that is used to prevent complications from the gastrointestinal tract must be able to do. What we conventionally call “gastroprotector” is probably not entirely correct.
If we are talking about a drug complication, we must think that this medicine should effectively heal an already developed complication. If we are faced with a situation where a patient received NSAIDs or low doses of Aspirin, and he developed multiple erosions or ulcers. In this situation, we must prescribe him a medicine that will quickly and effectively heal them.
We must hope that the medicine we use to treat NSAID-induced ulcers, Aspirin-induced ulcers, will also be effective in preventing them. We really understand that most of the patients who have already had complications will be forced to take these medications in the future.
13:08
It is very important that prevention is not limited only to the development and recurrence of endoscopic ulcers. This is, of course, an important but surrogate marker of complications. The most important thing is that the gastroprotector reduces the risk of developing the pathology that we fear most, that is, gastrointestinal bleeding.
In addition, we understand that the most common complication is, of course, a harmless complication, such as bleeding or manifestations of ulcers, but this is the development of dyspepsia. It is extremely important that the medicine we use for prevention has a very good effect in relieving dyspepsia and symptoms associated with GERD.
Such a medicine, which is widely used all over the world (one of the most popular gastroprotectors), is Esomeprazol. It has proven its effectiveness in all the positions that I spoke about today.
Data that show the effectiveness of Esomeprazole for the prevention of NSAID gastropathy. These are two large international studies “PLUTO” and “VENUS”. The interest of these studies is that the patients were separated. Some of them received traditional NSAIDs. Others received highly selective CO II inhibitors, that is, a new generation of NSAIDs. In both cases, Esomeprazole provided a clear, significant reduction in the risk of endoscopic ulcers and exacerbation of NSAID gastropathy, compared with those patients who received placebo.
An indicator that is key for us. How effectively Esomeprazole reduces the risk of major bleeding. Research done in Hong Kong, Professor Chen. This is a very large group of patients (400 patients) who have a history of NSAID-induced ulcers complicated by major bleeding. The ulcers were healed and the bleeding stopped. Helicobacter pylori (if it was) destroyed. Effective radiation was carried out.
Patients receive the highly selective CO II inhibitor Celecoxib for a year. A medicine that is quite safe in terms of the gastrointestinal tract. One group of patients receives only celecoxib 400 mg. The second is in combination with Esomeprazole 20 mg. During the year, the number of recurrences of major gastrointestinal bleeding is assessed, that is, those bleedings that required active treatment and hospitalization.
While taking this safest selective CO II inhibitor, there was a 9% relapse rate of major bleeding and not a single relapse among those patients who received the combination of Celecoxib with Esomeprazole. Very valuable and important data.
15:41
A study that was just published. This is the OBERON study. It shows the effectiveness of Esomeprazole for the prevention of gastrointestinal complications that arise from the use of low doses of Aspirin.
Huge selection. Almost 2,500 patients who receive Aspirin at a dosage of 75 – 325 mg and who have corresponding risk factors for NSAID gastropathy. Either old age or a history of ulcers. These are patients who were not infected with Helicobacter pylori.
Compared with placebo, Esomeprazole 20 or 40 mg provided a clear and distinct reduction in the risk of ulceration. On Esomeprazole it is 1.1.5%. 7.5% incidence of ulcers on placebo. This is very important and valuable data.
Effectively reduces the severity of dyspepsia. We understand perfectly well that for our patients, a subjective assessment of the safety of a drug is of fundamental nature. This is a very important point. Every 10th patient who starts taking NSAIDs stops using them precisely because of the development of dyspepsia, and not because of dangerous complications.
Two large studies, NASA and SPACE, demonstrate a decrease in the severity of dyspepsia in patients who regularly take NSAIDs for 4 weeks. It was clearly shown that with the use of Esomeprazole in dosages of 20 mg and 40 mg, there was a clear and significant decrease in the severity of discomfort from the gastrointestinal tract compared to those patients who received placebo.
17:15
The part of this research that concerns GERD. A question of principle. We also see that Esomeprazole is very effective and actively reduces the severity of symptoms associated with GERD (heartburn, sour belching) compared to those patients who receive placebo.
It is very important that we clearly understand in what situation we should prescribe proton pump inhibitors. This is a fundamental question. When we use them. We use them in situations where the patient has a high risk of relapse or the development of dangerous complications. These are those patients who have a history of gastrointestinal bleeding. These are those patients who have a history of recurrent gastric ulcers. These are those patients who have a history of complicated forms of GERD.
Regardless of which NSAIDs the patient takes, traditional or selective, in this situation he must receive a proton pump inhibitor to effectively prevent dangerous complications. We prescribe effective gastroprotective therapy in situations where patients have a combination of other risk factors for NSAID gastropathy.
Severe dyspepsia or symptoms of GERD are also direct indications for the prescription of proton pump inhibitors. This greatly increases the tolerability of this therapy. Certainly. If the patient fears that he will develop a serious complication when using certain medications, in this situation the use of proton pump inhibitors is completely justified. But the use of these drugs in those patients who do not have risk factors is completely questionable.
A very important point that is now coming to the fore. For us, it is of fundamental importance not only to prevent complications from the gastrointestinal tract, but also cardiovascular complications.
It is well known that the safest drug from the NSAID group, which most rarely causes complications from the cardiovascular system, is Naproxen. This medicine is widely used all over the world, but, unfortunately, is not very popular in Russia. Although we have several registered drugs of this type on the market. Naproxen, although it is the current gold standard for cardiac safety, is a drug that is not very well tolerated in the gastrointestinal tract. While taking Naproxen, ulcers often appear and bleeding develops.
The scientists were faced with the task of improving Naproxen, making it a more acceptable medicine for use in clinical practice. This path lies in creating a combination of Naproxen and effective proton pump inhibitors. Such a drug was created. This is a combination of Naproxen and Esomeprazole.
Large clinical trials have now been conducted, which clearly show that the combination of Naproxen and Esomeprazole significantly reduces the risk of gastrointestinal complications compared to those patients who receive Naproxen alone.
I think these combinations are the future of NSAID use.
Thank you very much for your attention.
Laxatives
Often, laxatives cope with their main purpose, however, the intestines can quickly get used to the drug, as a result of which constipation will only worsen. All types of medications have different effects on the intestines, so their choice should be approached carefully.
In pharmacies you can see medicinal products with both chemical composition and herbal components. A “natural” preparation usually involves adding crushed psyllium seed. The body, unlike chemical additives, does not get used to it, the medicine is safe for long-term use.
Strong laxatives must be taken on a full stomach, otherwise there is a risk of gastritis.
The gastrointestinal tract plays an important role in the life of the body. If you neglect the organ and ignore preventive measures, this can not only disrupt the natural rhythm of life, but also lead to a number of serious complications.
Medicines for the stomach and intestines in Moscow
This section presents medications for the treatment of the gastrointestinal tract, which you can order on the Here Pharmacy website and receive in one of 88 pharmacies in Moscow.
You can buy medicines for the stomach in Moscow in our online pharmacy.
Delivery of ordered intestinal medications is made only to pharmacies within the city of Moscow.
All drugs are certified and registered in the Russian Federation. You can check the certificates when purchasing goods at the pharmacy, and you can also order documentation to your email.
We have the means to treat any disease of the digestive system. The main drugs for the stomach and intestines by action:
- medications to decrease and increase secretory function;
- sorbents for rapid accumulation and removal of toxins;
- antispasmodics for pain relief;
- antibiotics for the treatment of bacterial diseases;
- enzymes to improve digestion.
You order medications for the intestines and stomach on the website, we deliver them to the specified pharmacy from among our partners. Delivery takes from 1 to 4 days. The redemption period is given 5 days from the date of delivery. Prescription drugs are available with a prescription.
