Digestive disorders include any disease or malfunction of the gastrointestinal tract, from the mouth to the anus, including the oesophagus, stomach, liver, pancreas, small intestine, and large intestine/colon. Common digestive disorders include nausea and vomiting, acid reflux/gastroesophageal reflux disease (GORD or GERD), diarrhoea, constipation, inflammatory bowel disease, irritable bowel syndrome (IBS), various cancers of the GI tract, gastroenteritis, peptic ulcer disease, diverticulitis, and structural issues such as obstructions, strictures, fissures, and haemorrhoids. Many common digestive disorders are functional disorders, meaning that the GI tract looks normal with examination and imaging, but that there are still symptoms. With structural issues, there are visible abnormalities in the gastrointestinal tract. These may require surgery. Symptoms associated with digestive disorders include abdominal pain, gas and bloating, bleeding, nausea and vomiting, diarrhoea, constipation, or a burning sensation in the oesophagus.
Many digestive disorders can be improved with changes in diet and lifestyle modifications. For example, high fibre diets can improve symptoms of constipation, and avoiding spicy foods can help with acid reflux symptoms. Viral gastroenteritis usually resolves on its own, or bacterial infections of the GI tract may need antibiotic therapy. Cancers of the GI tract may require surgery and usually need chemotherapy treatment. There are many medications that help resolve symptoms associated with digestive disorders and may help restore the function of the GI tract.
Antacids are available over the counter (OTC) without a prescription and contain chemicals that neutralize stomach acid to relieve heartburn symptoms. Common active ingredients include sodium bicarbonate, magnesium hydroxide, calcium carbonate, aluminum hydroxide, and sodium alginate. These are intended to treat mild symptoms and should not be used every day.
H2 Blockers reduce the amount of stomach acid produced by blocking receptors called histamine-2 receptors in the stomach to reduce heartburn/symptoms of gastroesophageal reflux disease. These can be used daily under healthcare provider supervision, or they can be taken as needed to relieve symptoms short-term. Examples include famotidine, ranitidine, and cimetidine.
Proton Pump Inhibitors (PPIs) reduce stomach acid production by blocking a hydrogen pump in the cells of the stomach lining. They can help heal the lining of the oesophagus in people with GERD/GORD and are the first-line recommended treatment for peptic ulcer disease. These medications are taken daily. Examples include pantoprazole, omeprazole, esomeprazole, and lansoprazole.
are used to help aid in passing a bowel movement and relieve constipation. Several different types are available, both prescription and OTC. Most are safe to be used regularly in patients with constipation due to multiple causes, including changes in diet and use of other medications, and are also used to soften the stool and promote easier bowel movements in patients who should not strain due to medical conditions such as post-surgery, haemorrhoids, or cardiac conditions. Most are taken orally, but a few are also available as an enema or suppository. Some OTC laxative medications include ingredients from more than one laxative class.
–Bulk-forming laxatives, which contain fibre, absorb water in the intestines to form bulky, soft stool that stimulates bowel muscles to work normally and pass the bowel movement. You must drink plenty of water with bulk-forming laxatives, or they can make constipation worse. Examples include psyllium fibre, polycarbophil, methylcellulose, and wheat dextrin.
–Osmotic laxatives pull water into the bowel to form soft stool and stimulate a bowel movement. Examples include polyethylene glycol (PEG), lactulose, sorbitol, and a group of laxatives called saline laxatives. Saline laxatives include magnesium citrate, sodium phosphate, and magnesium hydroxide. These are only safe for use in occasional constipation and are also used to clear the bowels prior to surgeries or procedures such as colonoscopy. Saline laxatives work quickly, within a few minutes to hours, while the other osmotic laxatives are slower, acting in 1-2 days.
–Stimulant laxatives work by causing muscle contractions in the intestines, which move the stool along through the bowels. These are available OTC but are more likely to cause side effects than other laxatives. Examples include bisacodyl, senna, and castor oil.
-Stool softeners, also known as emollient laxatives, do not induce a bowel movement, but increase the water content in the stool, making it softer and easier to pass. Examples include docusate sodium and docusate calcium.
Treat diarrhoea by slowing down GI tract movement, and decreasing the frequency of bowel movements, usually by acting on receptors in the intestinal wall lining. They are not always recommended, as diarrhoea is often the body’s natural way of getting rid of an intestinal infection. However, in chronic or severe cases, they may be used to prevent dehydration. Examples include loperamide and diphenoxylate/atropine.
Another type of antidiarrhoeal is kaolin/pectin, a liquid that is thought to bind to germs that cause diarrhoea and coats the intestines to relieve diarrhoea symptoms.
Are used to relieve symptoms of nausea and vomiting, which can be caused by a number medical conditions. Types of antiemetics and example medications are discussed below.
–Serotonin receptor antagonists affect the way the brain perceives nausea. These are available orally, and in intravenous (IV) formulations for when a patient is unable to tolerate oral medications. Examples include ondansetron, granisetron, and palonsetron.
–Antihistamines block receptors in the “vomiting centre” of the brain. Examples include promethazine, meclizine, diphenhydramine, dimenhydrinate, and doxylamine.
–Neurokinin receptor antagonists are a new class of medications that block the receptors that release substance P, a chemical in the brain that induces vomiting. Examples include aprepitant and fosaprepitant.
-Anticholinergics block receptors in the brain that trigger nausea and vomiting, and also decrease secretions in the GI tract and smooth muscle contractions involved in the act of vomiting. They are usually used for motion sickness and prevention of anaesthesia related nausea and vomiting. An example is scopolamine, which is used as a patch on the skin behind the ear.
–Dopamine receptor antagonists block dopamine, which is another brain chemical involved in nausea and vomiting. Examples include chlorpromazine, prochlorperazine, droperidol, and metoclopramide. Metoclopramide also blocks serotonin receptors, and is used as a “promotility” agent, meaning it helps the digestive system move downward. These medications are associated with increased side effects, so they are not used as first-line treatment.
Anti-gas medications can be used either to treat uncomfortable symptoms pain, pressure, and bloating associated with intestinal gas, or to prevent it. These are typically available over the counter. Simethicone works by breaking up gas bubbles in the stomach and intestines. Alpha-galactosidase and lactase work by helping the body break down the sugars in food that cause gas.
Anticholinergics/Antispasmodics help to relax the smooth muscle in the GI tract to ease abdominal pain in irritable bowel syndrome and other conditions. Examples include dicyclomine and hyoscyamine.
Mucosal protective agents bind to the stomach lining to help provide healing for and protection against gastric ulcers and acid reflux. Examples include sucralafate and misoprostol.
Anti-inflammatory agents designed specifically for the gastrointestinal tract are used to treat inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. Examples include budesonide and mesalamine.
Pancreatic enzymes are taken orally to aid digestion in patients who have a dysfunctional pancreas, such as in pancreatitis, pancreatic cancer, and Cystic Fibrosis. These are taken with food to work most effectively. Active ingredients include pancrelipase and amylase.
Hemorrhoidal treatments provide local relief for pain, itching, and swelling caused by internal and external haemorrhoids. They are usually creams or ointments applied to the rectum and are also available as suppositories or wipes. These products usually contain hydrocortisone, pramoxine, and/or witch hazel.
Can occur with most of these medications. The most common ones you may expect include:
-abdominal cramping
-dry mouth
-drowsiness
-dizziness
More serious side effects are possible and are usually related to long-term use of these medications. Therefore, it important to use these medications for as short a time period as possible. If you have symptoms that require continued use of most of these medications, you should seek medical attention, as a more serious underlying problem may be the culprit. Some of these medications are not recommended in particular health conditions. If you have diabetes or heart disease or are pregnant, you should seek advice from a medical professional before taking any of these medications. Serious symptoms associated with digestive disorders that require medical attention include severe pain, dehydration (dry skin, fatigue, weakness, decreased skin elasticity), blood in vomit or faeces (may be red, dark and tarry, or have a coffee ground appearance), heart palpitations, chest pain, fever, and unexplained weight loss.
Many digestive disorders can be prevented with a consistent diet that is high in fibre and low in sugar, as well as regular exercise, and proper infection control measures such as frequent hand washing and proper food handling and storage practices.