Antacids in real clinical practice

Abstract

Currently, proton pump inhibitors (PPIs), H2-histamine receptor blockers (H2-blockers), antacids, and anticholinergics are used to treat acid-dependent diseases of the gastrointestinal tract. PPIs are considered the most effective drugs for the treatment of acid-dependent diseases of the gastrointestinal tract. However, in real clinical practice, interest remains in the use of antacids in  acid-dependent diseases. This is due to the  fact that antacids not only adsorb hydrochloric acid in  the gastric lumen (by buffering the HCl present in the stomach, without a significant effect on its production) and reduce the proteolytic activity of gastric juice (reducing/ neutralizing the activity of pepsin), but also have a number of other pharmacotherapeutic properties demanded by the gastroenterological patient. Antacids in addition to antisecretory action have: 1) cytoprotective, primarily gastroprotective, action, which is mediated by: a) stimulation of the synthesis of bicarbonates and prostaglandins; b) mucoprotection – an increase in the production of protective mucus by epithelial cells; c) switching of the epithelial growth factor and its concentration in the area of erosive and ulcerative defects, which in turn activates angiogenesis, cell proliferation and local reparative and regenerative processes; 2) enveloping and adsorbing action, through chelation of lysolecithin and bile acids, which have an aggressive damaging effect on the upper gastrointestinal tract; 3) regulate gastroduodenal motility due to: a) antispasmodic action and streamlining gastroduodenal evacuation; b) decrease in intracavitary pressure in  the stomach and duodenum; b) obstacles to the  formation of  duodenogastric reflux. To date, combined preparations, the  basic composition of  which includes magnesium hydroxide and aluminum hydroxide, meet the  basic requirements for non-absorbable antacids. In conclusion, the authors present a number of clinical situations, indicating that today rationally prescribed antacid drugs successfully and significantly solve the main tasks of symptomatic therapy of acid-dependent and other diseases of the gastrointestinal tract, significantly improving the quality of life of patients.