Ulcers associated with NSAID use can be effectively healed by proton pump inhibitors. In cases where NSAID use is discontinued, more effective ulcer healing occurs. While continued use of NSAID reduces the amount of healing, some positive effects are still seen. Proton pump inhibitors are used among some populations daily to prevent potential complications from NSAID use, like bleeding or perforation. Proton pump inhibitors administered orally once or twice daily for a period of up to five days significantly reduces ulcer re-bleeding (the recurrence of bleeding from peptic ulcers) (Gwee et al., 2018). Manual therapy of the abdomen for someone who is experiencing acute ulcerative colitis is contraindicated. This is especially true if there is fever present from this condition. When someone is a subacute phase of this condition it is possible receive gentle relaxation manual therapy if it is comfortable, but it is also recommended to avoid abdominal massage altogether. Be sure to check in with the patient more often than normal about positioning and pressure throughout the session. of antacids are aluminum hydroxide gel* (Amphojel), calcium carbonate* (Tums), combination aluminum hydroxide and magnesium hydroxide preparations* (Maalox, Mylanta, Gaviscon), or sodium bicarbonate* (baking soda, Alka Seltzer) (Pope, 2023) Sodium bicarbonate reacts quickly with hydrochloric acid, producing carbon dioxide and sodium chloride, which may cause gastric distention and belching. When sodium bicarbonate is taken in high doses or by individuals with renal dysfunction, there is a potential for metabolic alkalosis due to absorption of unreacted alkali. Absorption of sodium chloride may exacerbate fluid retention, particularly in patients with hypertension, heart failure, and renal dysfunction (Shaw, 2017). Calcium carbonate is less soluble and reacts more slowly with hydrochloric acid than sodium bicarbonate, with a 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
symptoms including abdominal pain, diarrhea, nausea, and fever. The cause is unknown, but there may be a genetic component or predisposition (CDC, 2022). Abdominal massage has given many sufferers from IBD both immediate and long-term relief from symptoms. Working the abdomen with small circular pressures following the natural pathway of the large intestine has shown to effectively relieve stomach pains. Patients can perform this massage on themselves as well to help relieve acute symptoms. Ulcerative colitis Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, which then bleeds and produces pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea. It can be difficult to distinguish between ulcerative colitis and Crohn’s disease. Crohn’s disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach (Mayo Clinic, 2022). Gastrointestinal medications According to Almario et al. (2018), approximately 61% of people experience regular GI symptoms. Gastrointestinal medications are widely used and available over the counter and by prescription, and most patients wouldn’t think twice about omitting their use of a common antacid on their intake form when coming to receive therapy. Educating them on the interactions between manual therapy and certain medications, as well as specific benefits of manual therapy for certain GI conditions, is an integral part of a treatment plan to accommodate and aid your patients. There are several categories of hyperacidity medications. Hyperacidity conditions are caused by an overproduction and stimulation of stomach acids that results in the destruction of the epithelial cells that line the stomach and intestine. Antacids, H-2 receptor antagonists, mucosal protectants, antiflatulants, and proton pump inhibitors are all examples of commonly used hyperacidity medications. These categories make up a large portion of medications to treat GI disorders. Antacids Antacids neutralize stomach acids and are used to treat heartburn. Calcium carbonate is a common example of an antacid that is widely available over the counter, and safe to use for almost every population who is suffering from heartburn, indigestion, or upset stomach. Side effects are minimal, but constipation can occur. There are no known interactions between manual therapy and antacids (Cleveland Clinic, 2022). Antacids have a long history of nonprescription use in individuals with acid-peptic disorders and were the primary treatment strategy until the development of H2 receptor antagonists and proton pump inhibitors. Antacids are weak bases that react with hydrochloric acid in the gut to form saltwater. Their primary function is the reduction of intragastric acidity, but they may also enhance mucosal defense through increased mucosal prostaglandin production. The acid-neutralization capacity among different antacid formulas varies widely, depending on a range of factors including rate of dissolution (pill vs. liquid, for example), gastric contents and emptying, and so on (Salisbury & Terrell, 2023). There are three main types of antacid preparations: sodium bicarbonate, calcium carbonate, and magnesium or aluminum hydroxide. Common names with the preparations
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