1.What is colic syndrome? What are the manifestations of colic syndrome? How to diagnose and treat?
Abdominal Angina Syndrome (AAS) is a syndrome of postprandial epigastric or mid-abdominal pain caused by relative ischemia of the intestine. It is also called visceral colic, intestinal colic, intermittent ischemic peristalsis, intermittent abdominal claudication, ischemic abdominal syndrome, chronic visceral ischemia syndrome, intermittent mesenteric artery ischemia, and abdominal vascular insufficiency syndrome.
Stenosis or obstruction is caused by atherosclerosis at the openings of the gastrointestinal branches of the abdominal aorta. Most of the affected arteries occur in the superior mesenteric artery. Whenever there is an increase in intestinal blood flow and need after eating, it causes relative ischemia, hypoxia and spasm of the intestinal canal, producing significant abdominal colic pain.
The manifestations of abdominal colic syndrome are.
(1) Mostly seen in middle-aged and elderly male patients with other manifestations of atherosclerosis.
(2) Abdominal colic often occurs 15 to 30 minutes after a meal and lasts 1 to 3 hours, with the duration and intensity of pain related to the amount of food eaten. Abdominal colic can be a precursor of intestinal vascular infarction.
(3) It is accompanied by nausea and vomiting, diarrhea, and often reduced eating due to fear of pain, resulting in weight loss.
(4) Sometimes a systolic vascular murmur can be heard in the upper abdomen.
(5) Anemia, elevated white blood cells, and positive fecal occult blood may be present.
The following tests are helpful in the diagnosis of colic syndrome.
(1) Clinical manifestations of colic syndrome are present.
(2) No abnormal findings on abdominal x-ray.
(3) Abdominal arteriogram to determine the site and degree of stenosis or obstruction.
(4) Abdominal Doppler B-mode ultrasonography is useful for diagnosis.
The treatment measures are mainly abdominal artery or mesenteric artery reconstructive surgery. Dilation or recanalization of the stenotic or obstructed segment can also be performed via arterial catheter balloon. Pharmacological treatment may include vasodilators or anticoagulant therapy, antithrombotic pills or low-dose aspirin.
2.What is home nutritional support? Which patients can have home nutrition support?
Home nutrition support (HNS) refers to patients receiving nutritional support treatment in the home, including home enteral nutrition (HEN) and home parenteral nutrition (HPN). With the development of medical technology, especially the development of enteral nutrition preparation and tube placement technology, more and more patients can receive nutritional support treatment at home. Home nutrition can save patients’ cost, speed up the turnover of hospital beds, and more importantly, it allows patients to leave the hospital and return to the familiarity of their families, which provides emotional support to patients and families that cannot be compared with hospitalization. Home nutrition, especially home enteral nutrition, has been developing rapidly in recent years, with an annual growth rate of 20%-25% in Europe and America.
Home enteral nutrition is feasible for patients whose condition is stable and who can tolerate more than 70% of enteral nutrition in hospital, and whose main purpose of hospitalization is to perform enteral nutrition support to ensure adequate nutrition intake. These patients include those who are unable to eat by mouth or have insufficient oral intake and severe malnutrition due to various reasons, including neurological or mental disorders caused by cerebrovascular accidents, dysphagia caused by head and facial tumors, cachexia or upper gastrointestinal obstruction caused by advanced tumors, intestinal dysfunction or failure caused by various reasons, and severe malnutrition caused by other reasons. Patients for home enteral nutrition support in our department include patients with short bowel syndrome, chronic inflammatory intestinal diseases, intestinal fistula, recovery from severe pancreatitis, tumor causing dysphagia or upper gastrointestinal obstruction, tumor cachexia, inflammatory intestinal obstruction and perioperative nutrition support.
3.What preparations are needed for the family of the patient to be on home nutrition support?
First of all, we need to understand whether the patient is willing to receive home nutrition and whether enteral nutrition can be successfully implemented at home. The common problems are the financial burden and the caregiver’s problem. Some patients are generally well enough to take care of themselves. For patients in poor general condition, a dedicated family member or caregiver is necessary. Generally, patients need to be on nutritional support in the hospital for 3-7 days to gradually adapt to the full amount of enteral nutrition. During the infusion of nutrition solution, the patient and family members should learn next to each other and look for opportunities to ask questions to the medical staff; participate in systematic training for the patient, family members or caregivers in the hospital, including how to care for the tube, how to prepare and give nutritional preparations; common complications of enteral nutrition, such as catheter blockage, diarrhea, bloating and other general management, and under what circumstances should contact the medical staff; how to monitor and record How to monitor and record some basic conditions of the patient, etc.
4.How to carry out the care of enteral nutrition at home?
(1)Feeding tube care: The main ways of enteral nutrition are percutaneous gastrostomy tube, surgical gastrostomy tube, nasogastric tube or nasogastric tube, the focus of care is to maintain the catheter in place and patency, generally 4-6 h need to flush the tube with isotonic saline or warm boiled water 30 mL once, for the viscous nutrient solution containing fiber, the number of flushing should be increased appropriately or infusion with nutrition pump. Strengthen the fixation of the catheter, and fix the catheter on the skin or clothes according to the situation. Prevent infection around the stoma tube, pay attention to the cleanliness of the tube opening, and remove the secretion from the tube opening with a warm towel or iodine swab every day.
(2) Care of nutrition infusion process: choose the appropriate infusion method according to the general condition of the patient, such as patients with consciousness and swallowing disorder can be fed by tube in several times, while for patients with severe intestinal dysfunction, the infusion rate must be strictly controlled. Prevent the contamination of nutrition solution and nutrition solution from being too cold or too hot, and maintain the solution temperature at about 35℃.
(3) The care of drug administration: try to avoid the administration of drugs through the feeding tube. Some drugs must be adjusted in dose or changed in dosage form due to changes in the absorption route; some drugs may interact with the nutrient solution, resulting in denaturation of the nutrient solution and precipitation. All drugs that must be given through the tube must be approved by the physician and dissolved completely before being injected into the tube. Before and after drug administration, the tube must be flushed with 30 mL of warm boiled water to avoid blockage. Transdermal or injectable drugs must also be administered in strict accordance with the time and method, and the effect of the drug must be observed.
(4) Record the patient’s general condition: observe the patient’s daily urine volume, food intake, stool properties, whether the body has edema, and measure the patient’s body temperature and weight. For patients with drainage tubes, the amount of drainage fluid should be recorded daily. Record the patient’s complaints of thirst, weakness or pain, and report to the contact physician; if fever or respiratory distress occurs, communicate with the contact physician immediately.
5.What are the drugs for peptic ulcer disease? What are the precautions?
(a) Drugs to reduce acidity in the stomach.
(1) antacids: sodium bicarbonate (baking soda), fast acting, but can be completely absorbed by the gastrointestinal tract, causing sodium and alkali burden on the body, so the renal insufficiency and sodium retention of patients are not suitable for this drug, in addition, it reacts with acid in the stomach to produce carbon dioxide, which can lead to gastric distension and belching, and the risk of ulcer perforation, so it should not be used for a long time, the clinical application of this drug has been less, and now use its compound preparations include Gastrodex, Gastrodia, Gastrodia. Calcium carbonate, in the elderly may cause constipation, this drug and baking soda should not be taken with milk, because it may cause lacto-alkaline syndrome, at the same time, in the kidney patients should be prohibited calcium carbonate. Magnesium chloride, in patients with renal insufficiency and other patients may have toxic effects on the central nervous system and heart. Aluminum hydroxide, because it can simultaneously reduce phosphate in the body, it is suitable for patients with chronic renal insufficiency and hyperphosphatemia, but it can cause constipation, should not be used in patients with a history of intestinal obstruction. In addition there are aluminum phosphate, aluminum magnesium carbonate and magnesium trisilicate, magnesium salts have a slight laxative effect, long-term use of silica may occur urinary stones, uremic patients should also be prohibited antacids containing magnesium.
(2) histamine H2 receptor antagonists: cimetidine, this drug may mainly interfere with the role of other drugs, such as warfarin, Valium, Librium, anti-inflammatory pain, insulin, theophylline and phenytoin sodium, long-term use may produce male breast development and impotence, patients with poor renal function should reduce the dose, in addition it may also accelerate the rejection of skin graft tablets and kidney transplants, such patients taking should be noted. Ranitidine, Famotidine, Nizatidine and Rosatidine have less side effects than Cimetidine, Rosatidine may cause constipation and diarrhea.
(3) Proton pump inhibitors: omeprazole, may interfere with the metabolism of drugs such as valium and phenytoin sodium, while lansoprazole and pantoprazole have fewer side effects.
(B) Drugs to enhance mucosal resistance.
(1) Aluminum thioglycollate, which may produce constipation, should not be taken with food, antacids or other drugs.
(2) Colloidal bismuth (De-Nol), the only side effect is that it can make the tongue and feces black.
(3) Prostaglandin, which has mild side effects.
(4) Glycyrrhiza glabra extract – raw gastrone, some patients may have headache, hypertension, edema, sodium retention and hypokalemia after taking it, so use with caution in patients with hypertension, kidney disease, liver disease and heart disease.
(5) Zinc vinblastine, no serious side effects.
(6) Teprenone, no serious side effects.
(7) Metzolim-S granules: preferably taken after meals.
(8) Antigastrin: Proglutamine, may have mild insomnia, weakness, dry mouth, dizziness, etc.
(9) Antimuscarinic agents: pirenzepine and tilenzipine, generally considered inappropriate for the treatment of gastric ulcer, contraindicated in patients with glaucoma, prostatic hypertrophy, gastric outlet obstruction and reflux esophagitis.
(C) eradication of H. pylori drugs, mainly anti-microbial drugs, bismuth salts and proton pump inhibitors.
6.What are the commonly used drugs to help digestion? What are the precautions?
(1) Lactase raw (Table Fei Ming) : Lactase raw is a dry preparation of live lactic acid bacillus, which decomposes sugar in the intestine to produce lactic acid and increase the acidity in the intestine, thus inhibiting the propagation of intestinal pathogens and preventing protein fermentation. It can be used for indigestion, abnormal fermentation in the intestine, pediatric diarrhea and pediatric green stool, etc. However, it should be noted that it should not be used together with antibacterial agent, antibacterial agent or absorbent, such as taking it should be 2-3 hours apart; the powder should not be lumpy or have rotten odor or other bad smell.
(2) LACIDOPHILIN POWDER: It is also a digestive aid. It can be used for abnormal intestinal fermentation, indigestion, intestinal flatulence, enteritis and diarrhea caused by improper diet in children. The lactic acid generated after oral administration can increase the acidity in the stomach, induce the transformation of pepsinogen secreted by the main cell into pepsin, and also improve the activity of pepsin; decompose sugar in the intestine to produce lactic acid, which increases the acidity in the intestine, thus inhibiting the reproduction of spoilage bacteria in the intestine, preventing protein fermentation, and reducing gas production in the intestine.
(3) DL-Carnitine HCI: It can be used for abdominal distension, nausea, belching, heartburn caused by dysfunction of digestive organs, geriatric dyspepsia, gastrointestinal dysfunction caused by pregnancy, and anorexia in infants and children. It should be noted that patients with severe hyperacidity, chronic recurrent pancreatitis and acute pancreatitis with pain may aggravate the disease, so it is prohibited for such patients. Also, it should not be used with alkaline drugs.
(4) MULTIENZYME TABLETS: The pepsin contained in MULTIENZYME TABLETS can hydrolyze protein into peptone, and pancreatic protease can further hydrolyze peptone into short peptide, etc. Pancreatic amylase and pancreatic lipase act as digestive agents for starch and fat. It can be used for digestive disorders caused by pancreatic diseases and dyspepsia caused by pepsin deficiency or reduced digestive function. It should be noted that this medicine should be taken before meals.
(5) medilac-vita: It can be used to prevent and control indigestion, loss of appetite, malnutrition, diarrhea, constipation, bloating, abnormal fermentation in the intestinal tract, enteritis, and damage to intestinal mucosa caused by the use of antibiotics in children. Since this medicine contains live probiotics such as Streptococcus faecalis and Bacillus subtilis, it should be noted that the water temperature should not exceed 40 degrees Celsius when taking it.
(6) Combizym: It can be used for all kinds of digestive diseases and senile dyspepsia. However, it should be noted that it should not be used in the acute stage of acute pancreatitis and chronic pancreatitis.
(7) creon: It can be used for pancreatic exocrine deficiency such as chronic pancreatitis, post-pancreatic resection or gastrectomy, pancreatic duct or bile duct obstruction caused by tumor. It can also be used for pancreatic pain and pancreatic exocrine insufficiency in the elderly, as well as indigestion caused by pancreatic enzyme deficiency. However, it should not be used in the early stage of acute pancreatitis. The drug is occasionally seen diarrhea, constipation, gastric discomfort, nausea and skin rash and other adverse reactions.
(8) Amylase (glycolytic enzyme, amylase) (Diastasum): It can directly decompose starch in the body into easily absorbed dextrin and maltose, and promote the digestive effect of the gastrointestinal tract. It is mainly used to treat starch indigestion, abnormal fermentation and loss of appetite. However, it should be noted that when it is placed for too long or coexisted with acid or alkali, its glycolytic power gradually disappears, and it is advisable to use new preparation. This drug should be taken with meals.
(9) Pepsinum: Pepsin is a digestive aid, which can digest protein and make the coagulated protein decompose into peptone for digestion and absorption. It can be used together with dilute hydrochloric acid for indigestion caused by pepsin deficiency or post-disease digestive impairment. Since pepsin is most active in acidic environment, it is often added with dilute hydrochloric acid 1%-2% to form a combination for clinical use. Do not combine with alkaline drugs. This drug should be taken at mealtime or before meal. And violent stirring can make it less effective, and in the presence of heat, it will coagulate and degenerate.
(10) PAMCREATIN ENTERIC-COATED TABLETS: It is a digestive aid and is used for indigestion due to lack of pancreatic juice. Application of this drug should be noted in acidic conditions easily destroyed, when taking not chewed, should not be taken with acidic drugs. And with an equal amount of sodium bicarbonate at the same time, can increase the efficacy.
(11) Dages: It can be used for gastrointestinal and pancreatic digestive insufficiency. Insufficient bile secretion due to acute and chronic liver disorders. Indigestion in patients with biliary tract disorders and cholecystectomy. Indigestion caused by over-eating and high-fat food during the recovery period after illness. Symptomatic treatment of loss of appetite, overeating, abdominal fullness and flatulence, epigastric fullness and fatty stools. However, it should be noted that it should not be applied in acute severe hepatitis with intrahepatic bile duct occlusion and complete obstruction of the bile duct. Occasionally there are adverse reactions such as vomiting, soft stools or diarrhea. , (12) Xiang Sha Liuxiang
(12) Xiang Sha Liu Jun Zi Wan: It can benefit the qi and strengthen the spleen, harmonize the stomach and lower the rebellion. It is used for spleen deficiency, gas stagnation, distension and pain in the abdomen, indigestion, belching and erratic, vomiting and vomiting, loose stools and diarrhea.
7.How to choose anti-vomiting medicine?
Vomiting is a common symptom of many diseases in the gastrointestinal system and is also a protective mechanism. It is not easy to use antiemetics when the cause is unknown, such as food poisoning, chemical poisoning, etc. We should let the patient try to vomit out harmful substances. Antiemetics can relieve the patient’s pain and prevent dehydration and electrolyte disorders, and are often used clinically.
(1) morbutrin: has the function of stomachic and stop nausea and vomiting, its advantages do not have mental and neurological side effects, for the treatment of frequent delayed gastric emptying, gastritis accompanied by the occurrence of dyspepsia syndrome, can also treat functional, organic, infectious, dietary or nausea or vomiting caused by radiation therapy, with dopamine to promote the effectiveness of the treatment of “Parkinson’s disease Nausea and vomiting caused by “Parkinson’s disease” are special indications for this product. Mild abdominal cramps are an occasional side effect of morpholine. Infants and pregnant women are prohibited.
(2) Gastrodia: It is used for vomiting caused by digestive system diseases or improper diet. It can also be used for nausea and vomiting due to drug, radiation, traumatic brain injury and motion sickness. It is not easy to combine with anticholinergic drugs, such as atropine and scopolamine tablets, and its antiemetic effect is weakened. The symptoms are muscle tremor, muscle twitching of lower limbs, backward head tilt, slanting neck, paroxysmal upward gaze of both eyes, difficulty in vocalization, ataxia, which can disappear after discontinuation of the drug and can be treated with anticholinergic drugs in severe cases. Gastroflucan also has adverse effects such as upright hypotension. Therefore, it should not be abused by children, and should not be taken for a long time by mildly ill patients and the elderly, and reduced for those with renal insufficiency, and contraindicated for pregnant women. Psychotropic drugs chlorpromazine and haloperidol should not be combined with gastrofloxacin, otherwise neurological side effects are more likely to occur.
(3) Thiazide: It has a stabilizing and antiemetic effect, such as chlorpromazine, promethazine, can be used for patients with unknown reasons and nervousness, but the dosage of these drugs should not be too large, because of the side effects of drowsiness and the impact on liver function, so drivers, machine operators and athletes, liver patients are prohibited.
(4) antihistamine Benadryl (seasickness): Benadryl for seasickness, seasickness caused by vomiting, generally 30 minutes before taking a car, boat, plane to take a tablet.
(5) Vitamin B6: used for vomiting caused by anti-cancer and radiation therapy, also can be used for vomiting in early pregnancy.
(6) “Zuojin pill” “Zijin powder”: these two Chinese medicines have a certain effect on vomiting caused by high fever and stomach cold.
8.What are the commonly used laxatives? What are the precautions?
(1) phenolphthalein (non-norvastatin, fruit guide): It is a stimulating or contact laxative, which can be used for habitual obstinate constipation, and also for intestinal preparation during colon and rectal endoscopy or X-ray examination. This drug is used with caution in young children and pregnant women, and is contraindicated in infants. It should also not be used in cases of appendicitis, rectal bleeding without a clear diagnosis, congestive heart failure, hypertension, fecal mass obstruction, and intestinal obstruction. Habitual use of this drug should be avoided. Long-term or excessive use of this drug can cause intestinal dependence and even cause laxative colonization.
(2) liquid paraffin: not absorbed after taking, can make the stool diluted and soft, while lubricating the intestinal wall, so that the stool can be easily discharged. But should not be taken with long-term continuous, because it can block the absorption of fat-soluble vitamins.
(3) magnesium sulfate (bitter salt, laxative salt, laxative salt): orally not absorbed by the intestinal tract, is a volumetric laxative and biliary antispasmodic, can be used for diarrhea and duodenal drainage and treatment of biliary colic. Its diarrhea-inducing effect usually appears 2-8 hours after taking the drug, so it should be taken in the early morning on an empty stomach, and drink a lot of water to accelerate its diarrhea-inducing effect and prevent dehydration. Since it is a hypertonic laxative, it can lead to edema due to sodium retention, so it should be used with caution in pregnant women and those with poor renal function. In addition, intestinal bleeding, acute abdomen, heart block, myocardial damage and severe renal insufficiency are prohibited, and central inhibitory drug poisoning (such as Valium, commonly known as sleeping pills and chlorpromazine, Librium, etc.) should not be used to induce diarrhea and detoxification. In particular, we should emphasize that the application of this drug can cause severe conduction block or even cardiac arrest in patients who have digitalis, and patients with cardiovascular system diseases should pay particular attention to this drug, and should avoid taking this drug to induce diarrhea as far as possible.
(4) glycerin: this drug can lubricate and stimulate the intestinal wall, soften the stool, making it suitable for discharge, constipation can be applied to glycerin suppositories or 50% solution enema. Oral administration can have mild headache, dry mouth, itchy throat, nausea, vomiting and other discomforts, this side effect is more obvious when taken on an empty stomach, in addition, glycerin can increase the content of insulin in the plasma, interfering with the regulation of blood sugar in diabetic patients. Rectal administration may occasionally cause mucosal necrosis.
(5) Bisacodyl (stool stop): mainly acts on the large intestine, is a contact laxative. Can be applied to acute and chronic constipation and habitual constipation. To avoid stimulation of the stomach, this drug is enteric tablets, so do not chew the drug when taking, do not drink milk or take acidulants 2 hours before taking the drug. In addition, patients with acute abdominal disorders are prohibited.
(6) Marengen Rundown Pills: laxative, for intestinal dry constipation. This drug is contraindicated for pregnant women and used with caution during women’s menstruation. Severe organic diseases such as severe intestinal diverticula, intestinal tumors, intestinal obstruction and inflammatory bowel disease is prohibited. If you take it for 3 days without obvious effect or new symptoms, you should go to the hospital promptly.
9.What are the commonly used antidiarrheal drugs? What are the precautions?
Similar to vomiting, diarrhea is sometimes a protective mechanism of the body, which can help the body expel germs or toxin-causing substances from the body. For example, the use of antidiarrheal drugs in some infectious diarrhea should be cautious, and should be combined with effective anti-infective treatment and replenishment of water and electrolytes lost by the organism due to diarrhea, which can often stop on its own with the control of infection. In conclusion, the application of antidiarrheal drugs is not simple.
(1) Phenylephrine (difenoxylate, antidiarrheal): The effect of this drug on the intestine is similar to morphine, which acts directly on intestinal smooth muscle and weakens intestinal peristalsis by acting on intestinal mucosal receptors and eliminating the peristaltic reflex of local mucosa, which can enhance the absorption of water in the intestine by prolonging the passage time of intestinal contents. It can be used for acute and chronic functional diarrhea and chronic enteritis. However, long-term application can produce dependence, in addition, patients with liver disease and patients taking addictive drugs should be used with caution, this drug can not be used as the basic treatment of bacteriophageal dysentery.
(2) Loperamide (emmenagogue, phenylbuteramide, diarrhea idine): this drug can act on the opioid receptors of the intestinal wall, thereby inhibiting intestinal peristalsis, this drug can also increase the tension of the anal sphincter, which can inhibit fecal incontinence and stool urgency. This drug can be used for various acute and chronic diarrhea. For patients with ileostomy, this drug can increase the consistency of stool and reduce the number and quantity of stools. It is contraindicated in patients with intestinal obstruction, constipation, gastrointestinal distention or severe dehydration, acute attacks of ulcerative colitis and pseudomembranous enteritis caused by broad-spectrum antibiotics, and is contraindicated in infants and children under 2 years of age. This drug, like phenylephrine, should not be used as a basic medicine for bacterial dysentery with fever and blood in stool, and should be discontinued and replaced by other treatments if the symptoms do not ease after 48 hours of using this drug for acute diarrhea.
(3) Similac: Similac contains natural double octahedral montmorillonite particles, which can cover the gastrointestinal mucosa to enhance the mucosal barrier, chelate bile salts, remove pathogenic bacteria and toxins, support the normal intestinal flora, reduce intestinal sensitivity, etc. It is commonly used in various acute and chronic diarrhea. It is often used for various acute and chronic diarrhea. When applying, it should be noted that antibiotics taken orally at the same time can be adsorbed and eliminated from the body by Simethicone. At the same time, Simethicone can form a protective film in the intestinal tract and affect the efficacy of antibiotics. If it is necessary to take them together, they should be taken at least 2 hours apart. It is also recommended to take other medications at intervals with this drug if needed.
(4) Lidamidine: This drug can be used for chronic or fulminant diarrhea caused by colitis, segmental ileitis, ulcerative colitis and ulcerative proctitis, as well as diarrhea caused by gastrointestinal motility disorders or cancer and diabetic diarrhea. Adverse reactions of this drug include dry mouth, abdominal pain, upright hypotension, dizziness and hypoglycemia may occur with high dose application.
(5) Huo Xiang Zheng Qi Capsules: There are more dosage forms on the market at present, besides capsules, there are also water, pills, tablets, granules and oral liquid. Its function is to remove dampness, regulate qi and harmonize the middle. It can be used for summer dampness colds, headache, heaviness, chest tightness, or fever, distension and pain in the abdomen, vomiting and diarrhea. However, patients with chronic diseases such as hypertension, heart disease, liver disease, kidney disease, pregnant women and patients undergoing other treatments should consult a specialist before using this medicine.
10.What other aspects should be noted in the use of drugs for common digestive system diseases?
(1) Proton pump inhibitors in combination with bismuth: Both drugs are commonly used in gastroenterology. Proton pump inhibitors can block the proton pump on the microcystic membrane of gastric wall cells, so that hydrogen ion discharge is blocked, which can rapidly increase the pH value in the stomach after oral administration and improve the effect of antibiotics on H. pylori, which are mostly used in the treatment of peptic ulcer, commonly used drugs are omeprazole, lansoprazole, pantoprazole, rabeprazole, etc. Bismuth agents such as colloidal bismuth subcitrate need to be deposited in the form of bismuth salts in the gastric mucosa under the action of gastric acid to protect the ulcer surface and play the role of anti-pylori. When the two are taken orally at the same time, bismuth cannot function effectively because of the loss of acidic environment. Therefore, bismuth should not be taken orally at the same time with proton pump inhibitors. If they must be applied at the same time, the dosing time should be staggered to avoid affecting the efficacy.
(2)Bismuth agent is used in the treatment of upper gastrointestinal bleeding: excessive secretion of gastric acid caused by various factors leading to gastric mucous membrane damage is one of the common causes of upper gastrointestinal bleeding in patients. The gastric mucosa is mainly distributed with a large number of capillaries without smooth muscle walls, so the vascular hemostatic agents that generally act on smooth muscle cells are less effective, while the use of acid-control agents can receive better results. The principle is that the clot is rapidly digested in gastric acid with a pH value of less than 5, and acidulants achieve hemostasis by raising the pH value in the stomach, promoting platelet aggregation, and inducing plasma coagulation. However, during the activity of upper gastrointestinal bleeding, oral bismuth agents such as colloidal bismuth subcitrate can affect the evaluation of bleeding due to the formation of sulfide in the stomach and black stool, on the other hand, it may affect the efficacy of acid-making agents, so it is not suitable for the treatment of upper gastrointestinal bleeding.
(3) Ecological agents in combination with antibiotics: Intractable diarrhea is often associated with misuse of antibiotics leading to intestinal flora imbalance and proliferation of conditionally pathogenic bacteria. Ecological agents are one of the main clinical treatment drugs. There are two types of live bacterial preparations in common use: one type of preparation such as rectified intestine, Mia BM tablets, etc. can consume a large amount of oxygen in the intestine, causing an anaerobic environment and promoting the growth of anaerobic bacteria in order to restore the balance of the flora; the other type of drugs such as Rejuveno, Pepcid, etc. directly replenish the normal intestinal bacteria. In principle, live bacteria preparations are not used in combination with antibiotics, so as not to affect the efficacy. If you must apply ecological preparations and antibiotics at the same time, you can consider applying dead bacteria preparations such as billion live capsules (yeast preparations) or Lotol, this type of preparations are not affected by antibiotics.
(4) Combination of haloperidol with acid preparations: Patients with intestinal infections often present clinically with diarrhea, blood in the stool, urgency, and leukocytosis on stool examination. Quinolones have a broad antibacterial spectrum and are often used as the first choice for oral administration in intestinal infections. Because gastrointestinal symptoms often coexist, some people often combine haloperidol with acidulants. However, acidulants can affect the absorption of haloperidol and decrease the blood concentration, making it less effective. Magnesium aluminum carbonate can also affect the absorption of the drug, and should be avoided at the same time.
(5) Sulfasalazine with antibiotics: Sulfasalazine is one of the drugs commonly used in the treatment of ulcerative colitis. After oral administration, a small portion of sulfadiazine is absorbed in the gastrointestinal tract, while the remaining unabsorbed portion is broken down by intestinal bacteria into sulfapyridine and 5-aminosalicylic acid in the terminal ileum and colon. The mechanism of the drug is mainly through the inhibition of prostaglandin synthesis by 5-aminosalicylic acid. If antibiotics are applied at the same time, the amount of intestinal bacteria will be reduced, which will affect the breakdown of the drug and reduce its efficacy. Therefore, it is not advisable to combine salazosulfadiazine with antibiotics. In recent years, the application of 5-Aminosalicylic acid preparations such as Addisha because of the direct effect without bacterial decomposition, so it is not affected by antibiotics.
(6) organophosphorus pesticide poisoning application energy combination agent: organophosphorus pesticide poisoning is a critical disease of gastroenterology, the onset of the main manifestation of the toxic inhibition of the body cholinesterase acetate acetylcholine accumulation and clinical syndrome. Organophosphorus pesticide poisoning is often accompanied by damage to multiple organs, so energy synergists are often used clinically to assist in treatment. In vivo acetylcholine is synthesized by choline and acetyl coenzyme A under the action of choline acetylase, and intravenous injection of acetyl coenzyme A can aggravate the accumulation of acetylcholine. Acetyl coenzyme A is mainly oxidized through the triglyceride cycle, a process that is inhibited by ATP. ATP supplementation slows down the tris-hydroxylate cycle and increases acetylcholine synthesis. Therefore, it is not advisable to apply energy synergists in the rescue of organophosphorus pesticide poisoning.
(7) Cisapride in combination with antidepressants: Irritable bowel syndrome has many kinetic and psychiatric abnormalities, and prokinetic drugs and antidepressant therapy are more commonly used in clinical practice. Cisapride is a full gastrointestinal motility drug that selectively acts on 5-hydroxytryptamine receptors in the gastrointestinal wall to stimulate the release of acetylcholine from the intestinal interosseous plexus and thus promote gastrointestinal motility. Antidepressants such as promethazine, amitriptyline and doxorubicin are mostly tricyclic compounds, which play an antidepressant role mainly by blocking the reuptake of norepinephrine and 5-hydroxytryptophan. In recent years, the clinical use of 5-hydroxytryptophan reuptake drugs, such as paroxetine and fluoxetine. Cisapride and antidepressants are monoamine oxidase inhibitors, both of which inhibit hepatic cytochrome oxidase P450 isoenzymes. Therefore, the combination of the two drugs enhances the toxicity of the drugs to the liver.