As humans consume grains and legumes, the gastrointestinal tract bears the heaviest burden. With age, many unknowingly develop gastric disorders. Chronic conditions like atrophic gastritis, reflux esophagitis, gastric ulcers, or bile reflux gastritis weaken the stomach lining's protective mechanisms, leading to upper abdominal discomfort such as pain and bloating.At this stage, beyond dietary adjustments, heightened vigilance is crucial when taking the following medications orally or via injection. Today, our pharmacist discusses seven categories of drugs that require caution for individuals with gastric conditions.
Analgesic and antipyretic drugs
Medications like aspirin, indomethacin, piroxicam, phenylbutazone, diclofenac, and ibuprofen can damage the protective mechanisms of the gastric mucosa.After taking them, adverse reactions in the upper digestive tract are likely to occur, such as upper abdominal pain and discomfort, indigestion, or even gastrointestinal bleeding. Additionally, gastroscopy often reveals gastric mucosal inflammation, erosion, and ulcers, with severe cases potentially leading to ulcer perforation and bleeding. Therefore, patients with gastric diseases should minimize the use of such medications as much as possible.
Particular caution is warranted for patients with a history of peptic ulcers, Helicobacter pylori infection, cardiovascular diseases like coronary heart disease, or those currently taking warfarin or glucocorticoids.
If use is medically necessary, opt for relatively safer options like celecoxib or ibuprofen under physician guidance, adjusting dosage to the lowest effective level. Concurrently, combine with acid-suppressing agents such as omeprazole, pantoprazole, or misoprostol to protect gastrointestinal mucosa.
Adrenal Corticosteroids
These include dexamethasone, prednisone, prednisolone, methylprednisolone, betamethasone, and others. All such drugs can induce gastrointestinal ulcers or cause ulcers to recur or worsen.
Research indicates that glucocorticoids delay tissue healing, increase gastric acid and pepsin secretion, and reduce protective gastric mucus secretion, thereby diminishing the resistance of the gastric mucosa.For individuals with pre-existing gastric conditions, glucocorticoids may trigger or exacerbate gastric or duodenal ulcer bleeding, potentially leading to gastrointestinal perforation. Therefore, patients with gastric disorders should exercise caution when using glucocorticoid medications.
Gastrointestinal ulcers caused by adrenocortical hormones are also known as steroid ulcers. Their clinical symptoms differ slightly from typical peptic ulcers. The pain lacks a clear pattern, often occurring insidiously. The condition is frequently discovered only when the lesion is already severe, or even after bleeding or perforation occurs. This is because glucocorticoids elevate the pain perception threshold and reduce inflammatory responses.Therefore, close monitoring of gastrointestinal reactions is essential before and during use of these medications, particularly in patients with pre-existing ulcers.
Additionally, avoid concomitant use of glucocorticoids with salicylates, antipyretic analgesics, or antihistamines.Alcohol consumption should be avoided during treatment. Patients should follow a high-protein, high-vitamin diet suitable for peptic ulcer disease. Antacids and gastric mucosal protective agents may be added as needed. Antihypertensive drugs containing reserpine Examples include reserpine tablets, compound reserpine tablets, and compound reserpine-amantadine tablets.Reserpine stimulates excessive gastric acid secretion, potentially inducing or exacerbating gastric ulcer bleeding. Therefore, patients with gastric conditions should avoid antihypertensive drugs containing reserpine. The package inserts for these medications explicitly state "Contraindicated in patients with gastric or duodenal ulcers."
Medications containing calcium, potassium, iron, etc.
Examples include potassium chloride tablets, iron supplements, and calcium-containing supplements. Potassium chloride and iron supplements directly irritate the gastric mucosa.Common calcium supplements primarily contain calcium carbonate and vitamin D. These formulations may cause gastrointestinal adverse reactions such as belching, constipation, bloating, abdominal pain, flatulence, nausea, and vomiting. Long-term excessive intake of calcium carbonate can also lead to rebound increases in gastric acid secretion. Therefore, if you have a stomach condition, adjust the dosage and administration of these medications accordingly and closely monitor your gastrointestinal function.
Antibiotics
Many oral antibacterial drugs, such as tetracyclines, erythromycins, metronidazole, and nitrofurans, commonly cause nausea, vomiting, abdominal pain, and decreased appetite. They may exacerbate peptic ulcers or even lead to bleeding.Reports indicate that oral penicillin antibiotics may cause acute abdominal pain and gastrointestinal bleeding in addition to general gastrointestinal discomfort. Intravenous erythromycin infusion can also induce gastrointestinal symptoms, with occasional cases of digestive tract hemorrhage.
Polymyxin exhibits significant toxicity to gastric mucosal epithelial cells, potentially causing localized ischemia of the gastric mucosa and promoting histamine release, leading to gastritis and gastric mucosal damage.
Antineoplastic Drugs
Such as methotrexate, 6-mercaptopurine, and 5-fluorouracil derivatives. These drugs can stimulate diffuse inflammation, mucosal swelling, and erosion of the gastrointestinal mucosa, leading to gastritis or gastric ulcers, accompanied by symptoms like nausea, vomiting, and loss of appetite.
Heat-Clearing, Toxin-Resolving, and Bowel-Regulating Medications
Include Chinese herbal formulations with bitter-cold properties. Many patients experiencing "heatiness" or constipation opt for proprietary Chinese medicines with heat-clearing or bowel-regulating effects. These medications often contain herbs with bitter-cold properties, such as rhubarb, coptis, scutellaria, gypsum, artificial cowbane, and gardenia.
Theoretically, prolonged or excessive use of these "bitter-cold substances" may damage "spleen yang," leading to gastrointestinal discomfort like loss of appetite, bloating, and abdominal pain. Therefore, if you have a stomach condition and also exhibit a spleen-stomach deficiency-cold pattern, exercise particular caution when taking such herbal formulations.