The clinician has a wide and powerful array of OTC, supplemental, and herbal preparations to treat patients with upper and lower GI problems. Medications such as H2-blockers and proton pump inhibitors (PPIs), which were dramatic advances in the medical therapy of gastric and esophageal disorders, have now been deemed safe enough to make them available as OTC medications. A number of herbal and supplemental products are also highly effective alternatives or adjuncts to the treatment of both upper and lower GI problems.
The efficacy and potency of these agents is at times a double-edged sword because changes in GI function and absorption can have systemic risks and effects. These agents may also be potent enough to effectively treat the symptoms of a serious underlying disorder without addressing the root pathology, which can involve its own risks. Hence, there is a vital role for the informed practitioner to guide patients to the most effective therapy and help them to use it safely.
Upper GI active agents
H2-blockers
Benefits: Aid in healing of ulcers as well as treating mild to moderate gastroesophageal reflux disease (GERD). H2-blockers have additional analgesic effects that improve upper GI pain. They can be combined with PPIs and be effectively taken on an empty stomach.
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PPIs
Benefits: Higher healing rates for both esophagitis and ulcers. Treats moderate to severe GERD and gastroduodenal problems. Effective in preventing aspirin-induced ulceration in patients with prior gastropathy.
Cautions for both H2-blockers and PPIs: Both H2-blockers and PPIs suppress stomach acid and treat upper GI symptoms. The higher intensity the acid suppression (PPI > H2), the more likelihood of increased GI and pulmonary infections, osteoporosis, and B12 malabsorption.1 PPIs have also been found to cause rebound symptoms on discontinuation.
By treating the symptoms, H2-blockers and PPIs may mask an underlying malignancy and thus delay definitive diagnosis and treatment. If a patient has an ongoing need for the use of these medicines or symptoms despite their use, or they are in a high-risk group, then testing such as upper endoscopy is indicated. PPIs need to be taken prior to eating to be effective.
