Combination of gastric drugs why it does not work
Gastric diseases that are not cured for a long time are annoying, dissatisfying to patients and headaches to doctors. There are many factors, and it is difficult to express them in short words. This is only a brief experience on the combined use of drugs, for the reference of patients.
The treatment plan for chronic gastritis and peptic ulcer is based on the patient’s subjective symptoms and objective examination findings (including physical signs, gastroscopic visual observations and pathological findings or gastrointestinal x-ray performance), combined with the doctor’s own clinical experience and the drugs at hand can be applied and developed, both in principle and with flexibility. When single drug treatment is ineffective, a combination of drugs is often chosen. The combination of drugs in Chinese medicine is almost the first choice, patients who have seen Chinese medicine know that dozens of Chinese medicines boiled into a pot, the effect of the medicine plus and minus all rely on the prescribing doctor to pinpoint to the right, the right or not, the patient knows after taking. In fact, Western medicine is also the same.
Gastric disease treatment cannot be separated from four basic points: repair and strengthen the gastric mucosa defense; eliminate and inhibit the attack factors; restore and maintain the normal movement of the stomach and intestines; correct digestive malabsorption. If a patient has two or more problems, a combination of medications is almost inevitable in order to cure as soon as possible. Commonly used combinations are acid suppressants, gastric mucosal protectors, gastrointestinal motility agents and digestive enzymes. The physician will choose two or more drugs to be given to the patient in combination. However, the following principles should be followed, limited to space, is briefly explained.
I. Determine the primary and secondary drugs
The primary drug is used to treat the underlying disease, while the secondary drug is used to relieve secondary symptoms.
For example, for those who have excessive secretion of gastric acid mainly manifested as acid reflux, heartburn and pain in empty stomach, acid suppressants should be used mainly, supplemented by gastric acid neutralizers and gastric mucosa protectors. The latter is effective when taken at the onset of symptoms. The most commonly used gastric mucosal protective agents are bismuth and aluminum thioglycollate preparations. Both of them need to form insoluble colloids under gastric acid conditions to cover the gastric mucosa and ulcer surface, blocking them from gastric acid, proteases and bile. Therefore, acid suppressants and gastric mucosal protectors should not be taken at the same time, and it is advisable to take acid suppressants only one hour after taking gastric mucosal protectors. Otherwise, the effect of gastric mucosal protector will be reduced. Therefore, when stomach pain and heartburn are unbearable, you should take acid neutralizer and gastric mucosal protector first, which can quickly relieve the symptoms, and then take the main drug acid suppressant to keep suppressing acid in order to achieve good effect.
If it is mainly postprandial bloating and pain, it should be supplemented with gastric mucosal protector as the main drug and weaker acid suppressant to achieve good results.
Second, long-term and short-term medication
Long-term medication is used for complete cure or to consolidate the effect of treatment. Short-term medication is used to intensify the treatment or temporary occurrence of symptoms. For example, peptic ulcer with acid suppressants and gastric mucosal protective agents for long-term application. The dose of acid suppressants can be increased for a short period of time (usually within 1 week) for rapid pain relief, and thereafter taken at the usual dose. Patients with chronic gastritis with mainly hidden pain should use gastric mucosal protective agents for a long time, supplemented with gastroprokinetic drugs and weak acid suppressants for a short time. Long-term application of strong acid suppressants is not advisable for such patients. The digestive enzymes can be applied for a short period of time for those with obvious indigestion symptoms.
Third, weigh the advantages and disadvantages of drug combinations
Drug combination, mutual conflict is inevitable. For example, strong acid suppressant may not help gastric mucosa protector to maximize its effect, and it is not conducive to pepsin to play the role of digestive aid, because pepsin needs acid activation. Therefore, digestive enzymes should be taken separately from acid suppressants. This must be clearly explained to patients when they need to add digestive enzymes after taking acid suppressants for a long time. If pepsin and pepsin are applied together, the rapid entry of pepsin into the alkaline environment of the small intestine also affects its efficacy. Acid suppressants can also affect the absorption of prokinetic drugs. In this case, the physician should understand what the patient needs to address at the moment in order to determine the order of medication and avoid such conflicts. For example, take a gastrodynamic drug half an hour before a meal, digestive enzymes between meals, and acid suppressants between meals.
Fourth, pay attention to the impact of dietary habits on the effectiveness of drugs
Many patients believe that milk can nourish the stomach, but do not know that drinking milk before going to bed will promote the secretion of gastric acid at night, which is not good for patients with stomach problems. Another example is that you cannot drink milk and carbonated drinks or alcohol one hour before and after taking bismuth, which will reduce the effectiveness of the drug. Some patients are used to eat something to relieve the symptoms when the stomach is upset instead of taking gastric mucosa protector, resulting in the delay of the disease.
Five, understand the impact of excessive long-term use of drugs on the stomach and intestines
For bismuth and aluminum thiosulfate preparation patients are more alert, because bismuth over long-term use will cause skin darkening; over long-term use of aluminum thiosulfate will occur aluminum deposition encephalopathy. And these two drugs instructions are useful for seven days effect is not obvious should find a doctor’s warning, so over prolonged use is less likely to occur. Common is the long-term use of acid suppressants, which patients and even doctors can be negligent. Long-term use of acid suppressants can cause indigestion, abdominal bloating, causing stomach distension, mistakenly believe that the original disease is not well and strengthen the take, the worse the treatment. Long-term use of powerful acid suppressants can also cause vitamin deficiency, iron deficiency anemia, elevated liver enzymes, etc.
Six, the use of the correct regular course of treatment and maintenance treatment
Regular course of treatment is the key to cure stomach disease. But after the cure is not everything is fine. Poor diet, H. pylori reinfection, drugs that damage the gastric mucosa, and psychological factors may cause recurrence of gastric disease. Some patients need maintenance therapy including both continuous minimum dose therapy and intermittent therapy, depending on the doctor’s recommendation.
In short, the combination of drugs for gastric disease is often necessary, and if used well, the disease will be eliminated early and with less recurrence. On the contrary, it is difficult to heal and even secondary symptoms appear. This requires the joint efforts of the doctor and the patient, but of course, the doctor’s responsibility is heavier.