Prokinetics in GERD: a description of the action, indications, application

The use of prokinetics in GERD

In the treatment of any disease it is important to act on all of the links in the chain. Missing any manifestation of the disease can be treated it for a long time without success. Therefore, a comprehensive therapy often consists of multiple drugs.

For example, in some cases, in the treatment of GERD doctors recommend the use of prokinetics. Representatives of this group are often used for getting rid of nausea and vomiting. But there are other, equally important effects in these medicines.

The mechanism of action of prokinetics in GERD

The challenges prokinetics excellent job the following.

Primarily they improve the motor function of the esophagus and stomach that prevents the stagnation of food in these departments. The mechanism of their action in this case is unclear. It is assumed that prokinetics act directly on the muscular structure of the digestive system.
New generation drugs reduce the time of contact of the esophagus with hydrochloric acid, promoting rapid healing of erosions (places with defects in the mucosa).
Prokinetics increase the amplitude of contraction of the esophagus, so the food quickly passes through the digestive tube, the less irritating the affected mucosa.
They, unlike many, can directly affect on the lower esophageal sphincter (the muscle between the stomach and esophagus), increasing the pressure. The weak activity of this muscle causes food ball and hydrochloric acid are back and irritate the esophageal tube.

Until recently, such medicinal substances was prescribed with gastroesophageal reflux disease as monotherapy and has been effective in 70-80% of cases. But prolonged use often led to severe side effects, so now they are used according to indications and in addition to the basic treatment. Although the last generations have a far less adverse reactions.

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Representatives of this type of medication

Прокинетики при ГЭРБ: описание действия, показания, применение Prokinetics, also called antiemetic drugs exist for a long time, there are representatives of several generations of drugs:

blockers of dopamine receptors: the first representative is «Metoclopramide», followed by «Domperidone» («Motilium»), the following representative «itopride does»;

agonists 5-HT4 — receptors — «Tegaserod»;

but nowadays I try to use the new prokinetics in treatment of GERD, these include antagonists of 5-HT3 receptors, is «Tropisetron», «Alosetron», «Cilansetron» and others.

Doctors recommend the use of such medicinal substances for 10-14 days, three times a day and at bedtime. Specimens in the form of tablets and injections.

Indications for use of prokinetics

Прокинетики при ГЭРБ: описание действия, показания, применение In which case you should use the drug of this group:

for nausea and vomiting of various origins, including after serious rounds of chemotherapy regarding cancer;

these drugs are used for getting rid of hiccups («Metoclopramide»);

for violation of motor function of the esophagus and the gastro-intestinal tract (surgery on the internal organs, traumatic injuries);

if there are functional disorders of the gastrointestinal tract (hypotension);

these drugs ease the symptoms of migraine headaches (but they are not completely replace the need for the use of specific therapy);

prescribe prokinetics and reflux esophagitis if the cause of the disease was a violation of the activity of the muscles of the stomach.

Prokinetics do not violate the secretory function of the stomach (i.e., do not affect the production of gastric juice). Despite all the positive aspects in the treatment of this disease alone was not enough to completely get rid of all symptoms caused by the development of GERD.

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Side effects of prokinetics

Прокинетики при ГЭРБ: описание действия, показания, применение The drug of the first generation («Metoclopramide») often recommended to take one-off or very short courses as it has a pronounced effect on the nervous system. The latest generation drugs have fewer side effects. In General, complications can be summarized as follows:

drowsiness, fatigue, dizziness, depression rare (more common with «Metoclopramide»);

there are minor headaches;

spastic pain and reduce the intestine;

sometimes people who take prokinetics, noted the emergence of constipation;

increased level of prolactin in blood plasma (the pituitary hormone influencing milk production in lactating mothers);

perhaps the appearance of noise in the ears, dry mouth;

rarely observed diarrhea;

sometimes from the respiratory organs were observed bronchospasm;

an allergic reaction to medication of any generation;

heart problems are arrhythmias (abnormal heart rhythm).

Most undesirable effects observed with the use of «Metoclopramide», which is why he was expelled from prolonged schemes of treatment of gastroesophageal reflux disease. He was appointed as auxiliary substances.

Contraindications

Прокинетики при ГЭРБ: описание действия, показания, применение In some cases, to use drugs from the group of prokinetics banned?

It is not recommended to use the injectable form of prokinetics, if a person drives a car, as were the cases of lower concentration.
If you are sensitive to these drugs.
If you were gastrointestinal bleeding, intestinal obstruction.
Heavy violations of functions of internal organs — liver failure, expressed violations of the kidneys.
Older sources said that pregnant women are not recommended to use such substances only in the first trimester, but recent revisions prokinetics generally not prescribed to pregnant and lactating mothers.

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Prokinetics in the fight with GERD use long time and very successfully. But due to the large number of complications in their application, can such substances be administered alone, without the recommendations of doctors. Advice professionals the appropriateness of their use will not be superfluous, because we are talking about health.