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SummarySummary: In the treatment of peptic ulcer, antacids should only be used when required for pain relief; for this purpose, any of the relatively non-“potent” antacids such as tablet preparations appear adequate. Antacids containing calcium carbonate and sodium bicarbonate should not be used.The roie of anticholinergic drugs has not been fully defined. Satisfactory preparations as regards pharmacological effect include glycopyrronium, isopropamide, oxyphencyclimine, poldine and propantheline. When used clinically, pharmacologically effective doses must be given.Of all the preparations submitted to clinical trial, only carbenoxotone sodium, without exception, has been shown to accelerate the healing of chronic gastric ulcers. It is as effective as bed rest in hospital patients. It has the disadvantage that it causes water and salt retention but this comp/ication can be ignored in those who are young and who do not suffer from cardiac, renal or hepatic disease.Another new drug is metoclopramide which increases gastric emptying and has an anti-emetic effect.The situation regarding the toxic effects of drugs in the stomach is confused. However, there is no evidence that steroids cause peptic ulceration. Aspirin causes increased occult blood loss but its role in the aetiology of acute gastrointestinal haemorrhage is undecided. There may be a causal relationship between aspirin ingestion and chronic gastric ulcer.Immunosuppressive therapy is of value in active chronic hepatitis, although there is no general agreement as to the best form of therapy.Ascites due to hepatic cirrhosis can be controlled by combining a diuretic which acts on the proximal tubule with one which acts on the distal tubule. Supplemental potassium chloride is required.Drug induced jaundice is an ever-increasing complication of modern chemotherapy. Jaundice is a rare complication of oral contraceptive administration. It is cholestatic in type and about half of the women affected have suffered from cholestatic jaundice of late pregnancy or pruritus of pregnancy.Phenobarbitone has been used successfully to reduce serum bilirubin levels in some patients with congenital unconjugated hyperbilirubinaemia, presumably by inducing hepatic glucuronyl transferase.In acute pancreatitis basal levels of pancreatic secretion can be achieved by efficient gastric decompression; anticholinergics are of value when this cannot be assured. The value of antitryptics, both in preoperative prophylaxis and in treatment, is in doubt; they have minimal side-effects, are of no value in small doses, and are ineffective after the earliest stage of the disease. There has been increasing emphasis on the need for more aggressive resuscitative and supportive measures.In chronic pancreatitis refinements have been made in the method of administration of pancreatic enzymes and a re-emphasis of the dietary measures to control steatorrhoea and its attendant metabolic disturbances. Medium chain triglycerides have been shown to be of value as adjunctive therapy in the undernourished child with cystic fibrosis and in patients with pancreatic steatorrhoea not completely controlled by diet and enzyme preparations.In the treatment of proctitis and ulcerative colitis it is now possible to select sulphasalazine, prednisolone sodium phosphate enemas or suppositories, or oral or systemic corticosteroids on the basis of their proven performance in clinical trials.Other trials have shown the value of drug therapy for Whipple’s disease, tropical sprue and possibly for irritable colon syndrome. A number of toxic reactions of importance have also been described, including reactions to enteric coated potassium, to antibiotics and to purgatives. |
