Clinically necessary! To improve indigestion, have you used these 6 types of drugs correctly?

This article is only for medical professionals to read and refer to a summary of 6 categories of drugs for improving indigestion and their selection! Dyspepsia is a group of common clinical symptoms, which mainly include upper abdomen pain, upper abdomen burning sensation, upper abdomen fullness after a meal and early satiety, as well as upper abdomen flatulence, nausea, vomiting, loss of appetite, anorexia and belching, etc.
It can be accompanied by diarrhea, which can be divided into functional dyspepsia (FD) and organic dyspepsia (OD) according to different causes
.

At present, drugs for improving dyspepsia include prokinetic drugs, digestive enzyme preparations, probiotic preparations, acid inhibitors, progesterone analogs, glucocorticoids and so on
.

1.
Six categories of drugs for improving indigestion ■ Prokinetic drugs Prokinetic drugs such as domperidone, metoclopramide, itopride, cisapride, mosapride, etc.
, can promote normal peristalsis of the digestive tract and improve appetite , At the same time, it can improve the upper abdominal symptoms related to indigestion and meal, such as fullness of the upper abdomen after a meal, early satiety, etc.
, and can also play antiemetic effects
.

Note: adverse reactions are abdominal pain, diarrhea, dry mouth, heart palpitations, electrocardiogram QT interval prolongation and so on
.

Domperidone can increase blood prolactin levels, causing non-lactation lactation
.

Metoclopramide easily penetrates the blood-brain barrier and can block central dopamine receptors and cause extrapyramidal reactions, especially in the elderly, causing sleepiness, irritability, tremor, hemifacial spasm, tardive dyskinesia, etc.
Jinsen-like symptoms; blocking pituitary dopamine receptors can cause hyperprolactinemia, causing breast tenderness, lactation and irregular menstruation
.

■ Digestive enzyme preparations Digestive enzyme preparations such as pancreatin enteric-coated capsules, compound digestive enzyme capsules, compound azimide enteric-coated tablets, Aspergillus oryzae pancreatin tablets, multi-enzyme tablets, etc.
, help the digestion and absorption of food and promote excretion Being empty can improve the symptoms of indigestion such as upper abdomen fullness and poor appetite, and at the same time improve loss of appetite
.

Note: Pancreatic enzyme enteric-coated capsules are contraindicated in the early stage of acute pancreatitis and the acute stage of chronic pancreatitis
.

Compound digestive enzyme capsules are contraindicated in patients with acute hepatitis and complete biliary obstruction
.

Compound azinamide enteric-coated tablets are contraindicated in patients with liver dysfunction, acute hepatitis, biliary obstruction and biliary colic
.

Aspergillus oryzae pancreatin tablets are contraindicated in the early stage of acute pancreatitis and the acute stage of chronic pancreatitis
.

■ Probiotic preparations Probiotic preparations contain Bifidobacterium, Lactobacillus, Streptococcus faecalis, Bacillus subtilis, Clostridium butyricum and other probiotic preparations, which can improve the symptoms of abdominal distension and loss of appetite related to meals
.

Note: Adverse reactions include gastrointestinal reactions such as nausea, stomach discomfort, flatulence, mild abdominal discomfort, abdominal pain, diarrhea, and abdominal distension.
The symptoms will disappear automatically as the time of administration is prolonged
.

Others include palpitations and dizziness
.

Rarely cause bacteremia, infective endocarditis and other risks, and it mostly occurs in patients with existing diseases
.

Immune deficiency and short bowel syndrome are contraindications
.

Most of the probiotic preparations are living microorganisms, and should not be used together with antibacterial drugs, so as not to affect the curative effect
.

If you need to use antibacterial drugs in combination, you should increase the dose of probiotic preparations or stagger the medication time, preferably at an interval of more than 2-3 hours
.

Saccharomyces boulardii, butyric acid bacteria and bacillus preparations are not sensitive to antibacterial drugs and can be used together with antibacterial drugs
.

■ Acid inhibitors Acid inhibitors such as proton pump inhibitors (PPI) and H2 receptor antagonists can improve upper abdominal pain, burning, and acid regurgitation symptoms of non-meal-related indigestion
.

Note: PPI adverse reactions including neutropenia, headache, diarrhea, loss of appetite, vitamin deficiency, mineral deficiency, secondary infections, osteoporosis, hip fracture, displacement and other intestinal flora
.

H2 receptor antagonists are easy to tolerate quickly.
If they are older, with renal impairment and other diseases, they are prone to adverse reactions such as diarrhea, headache, lethargy, fatigue, constipation, etc.
, and the elderly should be used with caution
.

■ Progesterone analogs Progesterone analogs are appetite stimulators/appetite promoting agents, which can increase appetite and food intake, increase body mass, and improve nutritional indicators
.

For example, megestrol acetate (MA) and medroxyprogesterone acetate (MPA), which are synthetic and orally active progesterone derivatives, may stimulate appetite through hypothalamic neuropeptide Y (NPY), and have sugar The activity of corticosteroids is similar to glucocorticoids, and it can also down-regulate the synthesis and release of pro-inflammatory cytokines to play an anti-inflammatory effect
.

The "Expert Consensus on Appetite Evaluation and Regulation of Cancer Patients" (2020) pointed out that the dose of megestrol for appetite improvement is 160 mg/d, and the best dose for weight gain is 400 mg/d
.

Medroxyprogesterone is used for patients with advanced tumor cachexia, orally 1000 mg/d (equivalent to 160 mg/d of megestrol)
.

The increase in body mass associated with MA and MPA is mainly the increase in adipose tissue rather than the increase in skeletal muscle.
The increase in weight is mainly due to increased body fat content and mild edema, but it has not been confirmed to increase lean body mass, and there is no right Fat body weight has obvious protective effect
.

Note: Adverse reactions include increased thromboembolism, uterine bleeding, vaginal atrophy, vaginal bleeding, peripheral edema, hyperglycemia, water and sodium retention, hypertension, adrenal suppression and adrenal dysfunction (abrupt withdrawal), flushing, sexual dysfunction , impotence and so on
.

Caution is required when used for patients with tumor cachexia that are associated with thrombotic diseases, heart disease, and fluid retention
.

■ Glucocorticoid Glucocorticoid is an appetite stimulant, which can improve appetite, and its degree is similar to MA.
It can reduce pro-inflammatory cytokines and increase the expression of neuropeptide-γ and neuropeptide NPY1 receptors.
It can stimulate appetite in a short period of time.
It can significantly improve appetite, improve physical status and control pain, but has no obvious effect on body weight.
It is recommended to use low-dose, short-term use, and not long-term use
.

The "Guidelines for the Basic Medications for Palliative Care and Nursing Care" (2021) pointed out that glucocorticoids such as dexamethasone orally, 4-8mg/d, for 2 weeks can increase appetite and improve subjective feelings, but Can not increase their weight, only suitable for the end-stage of the disease, and generally should not exceed 2 weeks
.

Note: adverse reactions, such as debilitating, sodium retention, metabolic disorders, protein breakdown, hypokalemia, hyperglycemia, abnormal blood pressure, osteoporosis, osteonecrosis, muscle atrophy, immune suppression, insanity and so on
.

2.
The choice of drugs for dyspepsia The onset of FD may be related to gastrointestinal motor dysfunction, visceral hypersensitivity (satisfaction or dull pain in the upper abdomen, early satiety and other symptoms), abnormal gastric acid secretion, Helicobacter pylori (Hp) infection and mental health Psychological factors and other related factors, according to the main symptoms, can be divided into epigastric pain syndrome (EPS, manifested as epigastric pain, epigastric burning sensation, and severe enough to affect daily activities, and the attack is at least 1 day per week) or postprandial discomfort.
Signs (PDS, manifested as fullness and discomfort after a meal, early fullness, and enough to affect daily activities, and the attack is at least 3 days a week)
.

Organic dyspepsia is most common with peptic ulcer and gastroesophageal reflux disease (GERD).
Others include gastrointestinal tumors, hepatobiliary malignancies, chronic pancreatic disease, diabetes, chronic renal insufficiency, congestive heart failure, and hyperthyroidism.
Minus and so on
.

①For meal-related dyspepsia (such as PDS), prokinetic drugs or combined acid inhibitors can be the first choice; for non-meal-related dyspepsia/acid-related dyspepsia (such as EPS), acid inhibitors can be used, and prokinetics can be used when necessary Drugs
.

②The symptoms of postprandial satiety and early satiety are the main symptoms, and prokinetic drugs should be used
.

Acid inhibitors and antacids have obvious effects on alleviating the symptoms of hunger pain, acid reflux and heartburn.
For FD with the above abdominal pain as the main symptom, the effect of PPI is better than that of H2 receptor antagonists
.

The duration of empirical treatment is generally 2-4 weeks
.

③ Symptoms occur before meals and disappear after meals.
Most symptoms are related to gastric acid.
Acid inhibitors and antacids are the first choice for treatment; asymptomatic before meals, symptoms appear after meals, suggesting that diseases are mostly related to gastrointestinal motility disorders.
Promoting is preferred Medications: Symptoms occur before meals and worsen after meals, suggesting that the disease is related to gastrointestinal motility disorders and gastric acid abnormalities.
Prokinetic drugs and acid inhibitors can be used in combination.
The course of treatment is generally 2-4 weeks
.

④For diabetic gastroparesis, you can choose metoclopramide, domperidone, and macrolide drugs.
Metoclopramide is recommended for short-term use.
Only severe gastroparesis where other drugs are ineffective should be considered for more than 5 days.
Lactone drugs are used as alternative drugs for gastroparesis in diabetic patients
.

⑤ Tumor loss of appetite (tumor cachexia), progesterone analogs, glucocorticoids, prokinetic drugs, digestive enzyme preparations, etc.
can be used
.

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Research progress in drug therapy of cancer cachexia[J].
Xuzhou Medical College Journal,2006,26(1):90-94[22]Liu Aiguo et al.
Research Progress in Cancer Cachexia[J].
Cancer Progress,2003,1(2,3):126-130[23] Evaluation and Regulation of Appetite in Cancer Patients Expert consensus[J].
Electronic Journal of Tumor Metabolism and Nutrition,2020,7(2):169-177[24]Zhang Lei et al.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
China Medicine Science,2016,6(6):15-18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral and Enteral Nutrition,2000,7(3):182-186[26]Glucocorticoids Guidelines for the clinical application of similar drugs[J].
Chinese Journal of Endocrinology and Metabolism,2012,28:Supplement 2a-1-32[27]Chen Xinqian et al.
Chen Xinqian's new pharmacology[M].
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Chinese Journal of Diabetes, 2018,10(1):30-31[30]Guidelines for the Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I)[J].
Chinese Journal of Diabetes,2019,11(2):100-103[31]Zeng Weiqiang et al.
Tumor Therapeutic Pharmacy Care Path[M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-331379-384[17]A guide to basic medications for palliative care and tranquillity care[J].
Chinese General Practice,2021,24(14):1717-1734[18]Tong Rongsheng, etc.
.
Drug comparison and clinical rational choice-tumor fascicle[ M].
Beijing:People's Medical Publishing House,2018:374-378[19]Wang Xudong et al.
Research progress in cancer anorexia cachexia syndrome[J].
The Journal of Practical Medicine,2008,24(16):2735-2737[20] Wang Lin.
Drug therapy strategy for tumor anorexia cachexia syndrome[J].
Chinese Journal of Medical Frontiers,2016,8(1):8-10[21].
Research progress in drug therapy of cancer cachexia[J].
Xuzhou Medical College Journal,2006,26(1):90-94[22]Liu Aiguo et al.
Research Progress in Cancer Cachexia[J].
Cancer Progress,2003,1(2,3):126-130[23] Evaluation and Regulation of Appetite in Cancer Patients Expert consensus[J].
Electronic Journal of Tumor Metabolism and Nutrition,2020,7(2):169-177[24]Zhang Lei et al.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
China Medicine Science,2016,6(6):15-18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral and Enteral Nutrition,2000,7(3):182-186[26]Glucocorticoids Guidelines for the clinical application of similar drugs[J].
Chinese Journal of Endocrinology and Metabolism,2012,28:Supplement 2a-1-32[27]Chen Xinqian et al.
Chen Xinqian's new pharmacology[M].
Beijing:People's Medical Publishing House,2018: 564-573[28] Professional knowledge of pharmacy (2)[M].
Beijing: China Medical Science and Technology Press, 2015: 082-085 [29] Chinese Type 2 Diabetes Prevention and Treatment Guidelines (2017 Edition)[J].
Chinese Journal of Diabetes, 2018,10(1):30-31[30]Guidelines for the Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I)[J].
Chinese Journal of Diabetes,2019,11(2):100-103[31]Zeng Weiqiang et al.
Tumor Therapeutic Pharmacy Care Path[M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-3312018:374-378[19]Wang Xudong et al.
Research progress of cancer anorexia cachexia syndrome[J].
Journal of Practical Medicine,2008,24(16):2735-2737[20].
Drug therapy for tumor anorexia cachexia syndrome Strategy[J].
Chinese Journal of Medical Frontiers,2016,8(1):8-10[21]Shi Huichang et al.
Research progress in drug treatment of cancer cachexia[J].
Journal of Xuzhou Medical College,2006,26(1):90 -94[22].
Cancer cachexia research progress[J].
Cancer Progress,2003,1(2,3):126-130[23]Expert consensus on evaluation and regulation of appetite in cancer patients[J].
Tumor Metabolism and Electronic Journal of Nutrition,2020,7(2):169-177[24]Zhang Lei et al.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
Chinese Medical Science,2016,6(6):15 -18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral and Enteral Nutrition,2000,7(3):182-186[26]Guiding Principles for Clinical Application of Glucocorticoids[J].
Chinese Journal of Endocrinology and Metabolism, 2012, 28: Supplement 2a-1-32 [27] Chen Xinqian et al.
Chen Xinqian's new edition of Pharmacology [M].
Beijing: People's Medical Publishing House, 2018: 564-573 [28] Professional knowledge of pharmacy ( Two) [M].
Beijing: China Medical Science and Technology Press, 2015: 082-085 [29] China Type 2 Diabetes Prevention and Treatment Guidelines (2017 Edition) [J].
Chinese Journal of Diabetes, 2018,10(1): 30-31 [30]Guidelines for the Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I) [J].
Chinese Journal of Diabetes, 2019, 11(2): 100-103 [31] Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path [M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-3312018:374-378[19]Wang Xudong et al.
Research progress of cancer anorexia cachexia syndrome[J].
Journal of Practical Medicine,2008,24(16):2735-2737[20].
Drug therapy for tumor anorexia cachexia syndrome Strategy[J].
Chinese Journal of Medical Frontiers,2016,8(1):8-10[21]Shi Huichang et al.
Research progress in drug treatment of cancer cachexia[J].
Journal of Xuzhou Medical College,2006,26(1):90 -94[22].
Cancer cachexia research progress[J].
Cancer Progress,2003,1(2,3):126-130[23]Expert consensus on evaluation and regulation of appetite in cancer patients[J].
Tumor Metabolism and Electronic Journal of Nutrition,2020,7(2):169-177[24]Zhang Lei et al.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
Chinese Medical Science,2016,6(6):15 -18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral and Enteral Nutrition,2000,7(3):182-186[26]Guiding Principles for Clinical Application of Glucocorticoids[J].
Chinese Journal of Endocrinology and Metabolism, 2012, 28: Supplement 2a-1-32 [27] Chen Xinqian et al.
Chen Xinqian's new edition of Pharmacology [M].
Beijing: People's Medical Publishing House, 2018: 564-573 [28] Professional knowledge of pharmacy ( Two) [M].
Beijing: China Medical Science and Technology Press, 2015: 082-085 [29] China Type 2 Diabetes Prevention and Treatment Guidelines (2017 Edition) [J].
Chinese Journal of Diabetes, 2018,10(1): 30-31 [30]Guidelines for Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I) [J].
Chinese Journal of Diabetes, 2019, 11(2): 100-103 [31] Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path [M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-3312003,1(2,3):126-130[23]Expert consensus on appetite evaluation and regulation of cancer patients[J].
Electronic Journal of Tumor Metabolism and Nutrition,2020,7(2):169-177[24]Zhang Lei, etc.
.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
Chinese Medical Science,2016,6(6):15-18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral And enteral nutrition,2000,7(3):182-186[26] Guidelines for the clinical application of glucocorticoids[J].
Chinese Journal of Endocrinology and Metabolism,2012,28: Supplement 2a-1-32[27] Chen Xinqian et al.
Chen Xinqian's new compilation of pharmacology[M].
Beijing: People's Medical Publishing House, 2018: 564-573 [28] Pharmaceutical Professional Knowledge (2) [M].
Beijing: China Medical Science and Technology Press, 2015: 082-085 [29] Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2017 Edition) [J].
Chinese Journal of Diabetes, 2018,10(1): 30-31 [30] Guidelines for the Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I) [J].
Chinese Journal of Diabetes, 2019, 11(2): 100-103 [31] Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path[M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-3312003,1(2,3):126-130[23]Expert consensus on appetite evaluation and regulation of cancer patients[J].
Electronic Journal of Tumor Metabolism and Nutrition,2020,7(2):169-177[24]Zhang Lei, etc.
.
Screening and pharmaceutical intervention for anorexia-cachexia syndrome in patients with advanced malignant tumors[J].
Chinese Medical Science,2016,6(6):15-18[25].
Tumor cachexia mechanism and prevention and treatment strategies[J].
Parenteral And enteral nutrition,2000,7(3):182-186[26] Guidelines for the clinical application of glucocorticoids[J].
Chinese Journal of Endocrinology and Metabolism,2012,28: Supplement 2a-1-32[27] Chen Xinqian et al.
Chen Xinqian's new compilation of pharmacology[M].
Beijing: People's Medical Publishing House, 2018: 564-573 [28] Pharmaceutical Professional Knowledge (2) [M].
Beijing: China Medical Science and Technology Press, 2015: 082-085 [29] China Guidelines for Prevention and Treatment of Type 2 Diabetes (2017 Edition) [J].
Chinese Journal of Diabetes, 2018, 10(1): 30-31 [30] China Guidelines for Prevention and Treatment of Diabetic Foot (2019 Edition) (I) [J].
Chinese Journal of Diabetes, 2019, 11(2): 100-103 [31] Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path[M].
Shanghai: Shanghai World Book Publishing Company, 2019: 330-33130-31[30]Guidelines for Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I)[J].
Chinese Journal of Diabetes,2019,11(2):100-103[31]Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path[M] .
Shanghai: Shanghai World Book Publishing Company, 2019: 330-33130-31[30]Guidelines for Prevention and Treatment of Diabetic Foot in China (2019 Edition) (I)[J].
Chinese Journal of Diabetes,2019,11(2):100-103[31]Zeng Weiqiang et al.
Tumor Treatment Pharmaceutical Care Path[M] .
Shanghai: Shanghai World Book Publishing Company, 2019: 330-331