OTC and herbal 
treatment of upper
 and lower GI problems

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Aloe vera gel can be effective for GI issues.
Aloe vera gel can be effective for GI issues.

Bismuth subsalicylate


Benefits: Treats a wide variety of upper and lower GI symptoms, including heartburn, indigestion, nausea, upset stomach, and diarrhea and is even part of prescription regimens to eradicate Helicobacter pylori in combination with other agents. Effectively prevents and treats travelers' diarrhea.


Cautions: Avoid in children younger than 12 years old due to possible Reye's syndrome risk from salicylate component. Darkens stool, which can be confused with melanic stools. Not for continuous use.


Ginger supplements


Benefits: Ginger has been used in cooking, steeped in teas, and more recently used in supplements successfully to treat nausea. In addition, it has promotility and anti-inflammatory effects.2


Cautions: Generally well tolerated. Can stimulate bile flow, which may problematic in patients with gallstones or hepatobiliary obstruction.


Melatonin


Benefits: Improves reflux by increasing lower esophageal sphincter (LES) pressure. This has allowed numerous individuals to discontinue PPI therapy, and it also helps sleep. Anticancer properties are being studied. The dose needed for LES effects is generally in the range of 3 to 5 mg per day.3


Cautions: Needs to be taken two to three hours prior to going to bed to help sleep. May cause vivid dreams.


Zinc and zinc-carnosine 


Benefits: Zinc alone has anti-inflammatory and gastroprotective effects. Zinc-carnosine has even stronger effects and specifically has been shown to speed up the healing of ulcers. It may also improve the elimination of Helicobacter pylori in combination with other agents.


Cautions: Zinc and zinc-carnosine can cause nausea, vomiting, and kidney and stomach damage, and it can have a metallic taste.


TABLE 1. Selected agents for upper GI problems

H2-blockers
  • famotidine (Pepcid AC)
  • ranitidine (Zantac 150)
  • others
PPIs
  • omeprazole (Prilosec OTC)
  • lansoprazole (Prevacid 24HR)
  • others
Bismuth subsalicylate
  • bismuth subsalicylate (Pepto-Bismol, Kaopectate)
  • generics
Ginger
  • Ginger Force (by New Chapter)
  • ginger root (by Nature's Way)
  • others
Melatonin
  • melatonin (Pure Encapsulations Melatonin;
    Nature's Way Melatonin Lozenge)
  • others
Zinc and zinc-
carnosine
Zinc-carnosine preparations:
  • Peptic-Care ZC (by Pure Encapsulations)
  • zinc carnosine (by Integrative Therapeutics
Zinc preparations:
  • zinc citrate (by Pure Encapsulations)
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