After reading this chapter, the student will:
Be able to recognize the signs, symptoms, and causes of peptic ulcer disease.
Be able to recognize the signs, symptoms, and causes of gastroesophageal reflux disease.
Understand the pharmacological treatment and adverse effects of drug therapy for peptic ulcer disease and gastroesophageal reflux disease.
Understand the etiology, pharmacological treatment, and adverse effects of drug therapy for diarrhea.
Understand the etiology, pharmacological treatment, and adverse effects of drug therapy for constipation and intestinal gas.
A vast array of gastrointestinal (GI) disorders can cause discomfort and stomach upset. Some of these disorders are peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), diarrhea, constipation, and intestinal gas. Most GI disorders, however, are never properly reported because athletes do not like to discuss such conditions. This chapter will focus on the common types of GI disorders; their etiology, signs and symptoms; and treatments that require drug management.
PUD is classified as a chronic inflammatory disorder resulting in the erosion of the mucosa of the stomach or duodenum. Usually, the erosion is a result of gastric acid and pepsin, which are normally available to hydrolyze protein and food so that they can be absorbed by the intestine. However, sometimes the production of gastric acid and pepsin results in ulcer formation. Ulcers also occur in the esophagus and other areas of the GI tract, but not as frequently as in the stomach and duodenum. Risk for developing ulcers increases with age, smoking, alcohol, a history of peptic ulcer disease or GI bleeding, and increased doses of nonsteroidal anti-inflammatory drugs (NSAIDs).19,35
Duodenal ulcers usually occur in the beginning portion of the duodenum and gastric ulcers usually occur in the lower one-third of the stomach, also called the antrum. PUD is often asymptomatic, but signs and symptoms can include a slight dull ache, discomfort 2 to 3 hours after meals and during the middle of the night, poor appetite, bloating, burping, nausea, and vomiting. Such discomfort can often be relieved by food and antacid medications.
The cause of PUD is multifactoral, ranging from increased acid secretion to factors that decrease the protective mucosal barrier. Neurologic impulses (sight, smell, or taste) can also trigger the secretion of acid. Damage to the mucosal barriers can occur as a consequence of alcohol abuse, cigarette smoking, or continual use of aspirin and NSAIDs. Helicobacter pylori (H. pylori) bacterial infection may also directly inflame and damage the mucosal barrier or alter the regulation of gastric acids. Because there are many factors that can cause ulcers, investigators have divided the etiology into three categories: (1) ulcers associated with H. pylori; (2) ulcers caused by NSAID use; and (3) ulcers caused by acid hypersecretion.14