Drugs Used in the Treatment of Gastrointestinal Diseases
Many
of the drug groups discussed elsewhere in this book have important applications
in the treatment of diseases of the gastro-intestinal tract and other organs.
Other groups are used almost exclusively for their effects on the gut; these
are discussed in the following text according to their therapeutic uses.
Acid-peptic diseases
include gastroesophageal reflux, peptic ulcer (gastric and duodenal), and
stress-related mucosal injury. In all these conditions, mucosal erosions or
ulceration arise when the caustic effects of aggressive factors (acid, pepsin,
bile) overwhelm the defensive factors of the gastrointestinal mucosa (mucus and
bicarbonate secretion, prostaglandins, blood flow, and the pro-cesses of
restitution and regeneration after cellular injury). Over 90% of peptic ulcers
are caused by infection with the bacterium Helicobacter
pylori or by use of nonsteroidal anti-inflammatorydrugs (NSAIDs). Drugs
used in the treatment of acid-peptic dis-orders may be divided into two
classes: agents that reduce intra-gastric acidity and agents that promote
mucosal defense.
A 21-year-old woman comes with her parents to discuss therapeutic options for her Crohn’s disease. She was diag-nosed with Crohn’s disease 2 years ago, and it involves her terminal ileum and proximal colon, as confirmed by colonos-copy and small bowel radiography. She was initially treated with mesalamine and budesonide with good response, but over the last 2 months, she has had a relapse of her symp-toms. She is experiencing fatigue, cramping, abdominal pains, and nonbloody diarrhea up to 10 times daily, and she has had a 15-lb weight loss.She has no other significant medical or surgical history. Her current medications are mesalamine 2.4 g/d and budes-onide 9 mg/d. She appears thin and tired. Abdominal exam-ination reveals tenderness without guarding in the right lower quadrant; no masses are palpable. On perianal exami-nation, there is no tenderness, fissure, or fistula. Her labora-tory data are notable for anemia and elevated C-reactive protein. What are the options for immediate control of her symptoms and disease? What are the long-term management options?
The
immediate goals of therapy are to improve this young woman’s symptoms of
abdominal pain, diarrhea, weight loss, and fatigue. Equally important goals are
to reduce the intes-tinal inflammation in hopes of preventing progression to
intestinal stenosis, fistulization, and need for surgery. One option now is to
“step up” her therapy by giving her a slow, tapering course of systemic
corticosteroids (eg, prednisone) for 8–12 weeks in order to quickly bring her
symptoms and inflammation under control while also initiating therapywith an
immunomodulator (eg, azathioprine or mercaptopu-rine) in hopes of achieving
long-term disease remission. If satisfactory disease control is not achieved
within 3–6 months, therapy with an anti-TNF agent then would be recom-mended.
Alternatively, patients with moderate-to-severe Crohn’s disease who have failed
mesalamine may be treated upfront with both
an anti-TNF agent and immunomodula-tors, which achieves higher remission rates
than either agent alone and may improve long-term outcomes.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.