therapeutic recommendation for GI symptoms (Nugent et al., 2023). Mucosal protectants Sucralfate is the most common component in mucosal protectants. Sucralfate is a salt that forms a viscous material that binds specifically to ulcers or areas of wear for a period up to 6 hours. It forms a physical barrier that prevents additional abrasion of the area as well as stimulating mucosal prostaglandin and bicarbonate secretion. This medication works locally to cover and protect ulcers, therefore helping prevent any further damage to the ulcer (Kudaravalli & John, 2022). Gastrointestinal mucosa produces a number of prostaglandins. Mucosal prostaglandins stimulate mucus and bicarbonate secretion and mucosal blood flow. These structures act similarly to hormones in that they stimulate target cells into action but differ from hormones in the fact that they act locally, near where they are produced. Misoprostol is a synthetic prostaglandin able to inhibit acid and protect mucosal areas by stimulating mucus and bicarbonate secretion and increasing mucosal blood flow (Krugh & Maani, 2023). Little sucralfate is absorbed by the body, and so it has few side effects. A common side effect of this medication is constipation, but there are no direct interactions between therapeutic massage and mucosal protectants. Long-term use leaves a residue of aluminum salt, and sucralfate should not be used for any length of time in patients with renal problems. Mucosal protective agents (specifically sucralfate) may interact with other medications, reducing their absorption by the body (Kudaravalli & John, 2022). Bismuth subsalicylate (Pepto Bismol) is the only bismuth compound available in the United States. Less than 1 percent of bismuth is absorbed, with more than 99 percent of the drug eliminated in the stool. Salicylate is easily absorbed and eliminated in the urine. Bismuth coats ulcers and erosions in the same way as sucralfate, producing a protective layer against gastric juices. Bismuth may also stimulate prostaglandin, bicarbonate, and mucus secretion. Bismuth subsalicylate tends to reduce bowel movement frequency and liquidity in the case of some diarrhea. Bismuth is sometimes taken before and during trips to counter potential microbial activity or increase in H. pylori (Budisak & Abbas, 2023). Bismuth compounds tend to blacken the stool but have few other side effects. Liquid formulas may also darken the tongue. Bismuth compounds should only be used for short periods of time and should not be used at all in individuals with poor renal function. Excessive or prolonged use of some bismuth compounds, but not bismuth subsalicylate, may result in symptoms of bismuth toxicity including headaches, confusion, unsteadiness, or seizures (Budisak & Abbas, 2023). Healthcare Consideration: Abdominal massage can be a great way to give relief to patients that are experiencing constipation, either as a GI pathology or as a side effect from an GI medication they are taking. It is important to stand on the patient’s left side when they are supine, or face up, on the table, enabling you to work in a clockwise motion, following the natural path of the large intestine. The intestine is composed of three parts, the ascending, transverse, and descending colons. It is important to work the intestines in this natural order.
reaction producing carbon dioxide and calcium chloride. Use of calcium carbonate may cause gastric distention, belching, and the potential for metabolic alkalosis. Excessive doses of sodium bicarbonate or calcium carbonate with a calcium-rich diet can cause hypercalcemia, renal insufficiency, and metabolic alkalosis (Garg et al., 2022). Magnesium hydroxide or aluminum hydroxide reacts with hydrochloric acid to form magnesium chloride or aluminum chloride and water. Distension and belching do not occur, as no gas is generated by this process. Potential for metabolic alkalosis is also avoided. As unabsorbed magnesium salts may produce osmotic diarrhea and aluminum salts may produce constipation, these two items are used together in several proprietary medications to minimize effects on bowel movements. Because both magnesium and aluminum are absorbed and excreted by the kidneys, any individuals with renal dysfunction should not take either formulation for any length of time (Garg et al., 2022). H-2 Receptor antagonists There are currently three FDA-approved H-2 receptor antagonist (H2RA) agents used in the United States. They are available either over the counter or by prescription only, dependent on the dose. The most commonly used H2RA is famotidine. This is available in an over-the-counter liquid or also with IV injection in a hospital or medical setting. H-2 receptors reduce decrease gastric acid secretion by reversibly binding to histamine H2-receptors. This medication is used to treat gastric or duodenal ulcers, gastric hypersecretion, heartburn, indigestion, and gastroesophageal reflux disease (GERD). Side effects of this medication can include headaches, drowsiness, abdominal pain, constipation, or diarrhea (Nugent et al., 2023). There is no direct interaction between therapeutic massage and over-the-counter H-2 receptor antagonists, but for a patient who is taking this medication, watch out for dizziness or light headedness, especially when turning the patient over on the table, and make sure they know the bathroom is available to them throughout the session as needed. H2 antagonists may be taken 30-60 minutes before meals to reduce meal-secreted acid by known food or beverage stomach irritants. They can be taken together with antacids for quick relief of symptoms and for longer results. as H2Ras last for longer periods of time. For the most effective approach, patients should take a daily dose of H2 antagonists at bedtime, or twice-daily doses (once in the morning and once in the evening). Patients should consult with their physicians about daily use of H2 antagonists (Nugent et al., 2023). H2 receptors reduce basal, meal-stimulated, and histamine- stimulated acid secretion, as well as gastrin, in a linear (dose-dependent) fashion. H2 antagonists work by binding to the H2 receptor, which blocks the binding by gastrin and acetylcholine that releases histamine from cells, reducing acid secretion in the process. Each of the H2RAs does this in a different fashion, with H2 receptors antagonists generally more useful in inhibiting the production of acid at night (largely a function of histamine) and having less of an impact on meal-stimulated acid (Nugent et al., 2023). Very few individuals taking H2 antagonists experience side effects and H2Ras are generally well-tolerated. Those who do may experience headaches, fatigue, constipation or diarrhea, and muscle pain. In cimetidine, specifically, long-term use or high dosages have been linked to gynecomastia, reduced sperm count, and impotence in men as well as galactorrhea in women. Cimetidine is a potent enzyme inhibitor and should be avoided with other medications that are metabolized by the same enzymes. Clinicians generally avoid prescribing cimetidine as a
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