Chapter 039. Nausea, Vomiting, and Indigestion (Part 5)

Chapter 039. Nausea, Vomiting, and Indigestion (Part 5)

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Gastrointestinal Motor Stimulants Drugs that stimulate gastric emptying are indicated for gastroparesis (Table 39-2). Metoclopramide, a combined 5-HT4 agonist and D2 antagonist, exhibits efficacy in gastroparesis, but antidopaminergic side effects limit its use in 25% of patients. Erythromycin, a macrolide antibiotic, increases gastroduodenal motility by action on receptors for motilin, an endogenous stimulant of fasting motor activity. Intravenous erythromycin is useful for inpatients with refractory gastroparesis; however, oral forms also have some utility. Domperidone, a D 2 antagonist not available in the United States, exhibits prokinetic and antiemetic effects but does not cross into most other brain regions; thus, anxiety...

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Chapter 039. Nausea, Vomiting, and (Part 5) Motor Drugs that stimulate gastric emptying are indicated for (Table 39-2). a combined 5-HT4 agonist and D2 exhibits in but side effects limit its use in 25% of a macrolide increases motility by action on receptors for motilin, an stimulant of fasting motor is useful for with however, oral forms also have some utility. a D2 not available in the United States, exhibits and effects but does not cross into most other brain regions; thus, anxiety and dystonic are rare. The main side effects of relate to induction of via effects on pituitary regions served by a porous The 5-HT4 agonist tegaserod potently gastric emptying in with however, its effects on symptoms of gastric retention are unproven. with upper gut motility disorders pose Liquid of drugs may be as liquids empty from the stomach more rapidly than pills. can be in patients to oral drugs. may respond to the analogue which induces small motor Pyloric of toxin are reported in studies to benefit patients with Placement of a feeding reduces and overall health in some patients with who do not respond to drug therapy. Surgical options are limited for cases, but may improve with resection of the stomach. Implanted gastric may reduce symptoms, enhance improve quality of life, and decrease health care in patients with Clinical Settings agents such as cisplatin are intensely (Chap. 77). Given 5-HT3 prevent acute vomiting in most cases (Table 39-2). Optimal effects often are obtained with a 5-HT3 combined with a also exhibits efficacy in emesis, while such as lorazepam are useful in reducing nausea and Therapy of delayed emesis 1–5 days after is less NK1 (e.g., exhibit and effects during both the acute and delayed periods after such as long advocated for emesis, produce side effects and exhibit no more efficacy than agents. Most current drug regimens produce greater in vomiting than in nausea. The clinician should exercise caution in managing the pregnant patient with nausea. Studies of the effects of available agents provide results. Few trials have been performed in nausea of although such as meclizine and such as efficacy greater than placebo. Some offer therapies such as or ginger. emesis in cyclic vomiting syndrome is a In many treatment with tricyclic or can reduce the frequency of attacks. 5- HT3 combined with the sedating effects of a such as are a mainstay of treatment of acute symptom flares. Small studies report benefits with including the serotonin 5-HT1 agonist as well as certain newer drugs. The most common causes of are acid reflux and Other cases are a of a more serious organic Acid Reflux Acid reflux can result from a variety of defects. Reduced lower sphincter (LES) tone is an important cause of reflux in and it may also be a factor in patients without other systemic Many exhibit frequent transient LES during which acid bathes the and can the barrier function of the LES, whereas impaired body and reduced salivary secretion prolong acid exposure. The role of hiatal is most reflux patients exhibit hiatal hernias, most with hiatal hernias do not have excess