Fenugreek-Magical herb

Fenugreek is an annual herb with light green leaves and small white flowers. It’s of the pea family (Fabaceae) and also known as Greek hay (Trigonella foenum-graecum). The fenugreek plant stands erect at two to three feet tall, and the seed pods contain 10–20 small, flat, yellow-brown, pungent and aromatic seeds.

While Fenugreek is used for many different conditions there are simply not enough of research done that would fully support its effectiveness on any of them. Some of the most common uses are for treating stomach upset and lessening constipation. Women mostly use fenugreek to boost their milk supply after having a baby. Men on the other hand use it for erectile dysfunction or a condition called hernia. 

Does Fenugreek work for Breast Enlargement?

1.   The first reason is that fenugreek contains a huge amount of phytoestrogens. These phytoestrogens are known to be able to imitate estrogen, which is a hormone responsible for breast size.

2.   It boost the production of a hormone called prolactin. This hormone is also responsible for breasts growth, so by stimulating both of these hormones fenugreek is able to enhance the size of breasts for most women.

3.   It works by increasing the production of prolactin and also by imitating the effect of estrogen, which both are extremely beneficial for larger breasts.

Fenugreek powder Paste for breast massaging-

To prepare a paste you would need to mix a small amount of fenugreek powder with water. In the next step apply this paste on your breasts and massage them for 5-10 minutes. After additional 10 minutes you can rinse the paste off with water. In order to get noticeable results from this natural remedy it is best to repeat it 1-2 times per day for a couple of months. Fenugreek powder can be purchased already prepared in most local stores. Alternatively you can prepare the powder yourself by dry roasting and grinding these seeds.The second choice to try fenugreek extract or essential oil. Since fenugreek is being prepared in liquid form too, you can use it for massaging your breasts on a daily bases.

Gastroesophageal reflux disease

Gastroesophageal reflux disease is digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by Gastroesophageal reflux disease. Doctors said that some people suffer from Gastroesophageal reflux disease due to a situation called hiatal hernia. In most cases, Gastroesophageal reflux disease can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.

Gastroesophageal Reflux

Gastroesophageal means stomach and esophagus. Reflux refers to flow back or return. Thus, gastroesophageal reflux is the return of the stomach's contents back up into the esophagus.

In usual digestion, the lower esophageal sphincter open to permit food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occur after the lower esophageal sphincter is weak or relaxes inappropriately, allow the stomach's contents to flow up into the esophagus.

The severity of Gastroesophageal reflux disease depends on lower esophageal sphincter dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.

Role of Hiatal Hernia in Gastroesophageal reflux disease?

Some doctors think that a hiatal hernia may weaken the lower esophageal sphincter and raise the risk for gastroesophageal reflux. Hiatal hernia occurs as the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle differentiated the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus. Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may permit stomach contents to reflux more easily into the esophagus.

Coughing, vomiting, straining, or sudden physical exertion can cause raised pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also rise to this condition.

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply) or is complicated by severe Gastroesophageal reflux disease or esophagitis (inflammation of the esophagus). The doctor may execute surgery to reduce the size of the hernia or to prevent strangulation.

Factors that Contribute to Gastroesophageal reflux disease

Dietary and life style choice may give to Gastroesophageal reflux disease. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may cause reflux and heartburn. Studies show that cigarette smoking relaxes the lower esophageal sphincter. Obesity and pregnancy can also play a role in Gastroesophageal reflux disease symptoms.

Symptoms of Heartburn

Heartburn, also called acid indigestion, is the mainly common symptom of Gastroesophageal reflux disease and usually feels like a burning chest pain start behind the breastbone and moving upward to the neck and throat. Many people say it feels like food is coming back into the mouth leaving an acid or bitter taste.

The burning, pressure, or pain of heartburn can last as long as 2 hours and is often worse after eating. Lying down or bending over can also result in heartburn. Many people obtain relief by standing upright or by taking an antacid that clears acid out of the esophagus.

Heartburn pain is sometimes mistaken for the pain associated with heart disease or a heart attack, but there are differences. 

What Common in Heartburn and Gastroesophageal reflux disease?

More than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn. Many pregnant women experience daily heartburn. Recent studies show that Gastroesophageal reflux disease in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing, and other respiratory problems.

What Is the Treatment for Gastroesophageal reflux disease?

Doctors recommend lifestyle and dietary changes for most people needing treatment for Gastroesophageal reflux disease. Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials.

Avoiding foods and beverges that can weaken the lower esophageal sphincter

Avoiding foods and beverages that can weaken the lower esophageal sphincter is often recommended. These foods include chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Foods and beverages that can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products, and pepper, should also be avoided if they cause symptoms.

Decreasing the size of portions at mealtime in Gastroesophageal reflux disease

Decreasing the extent of portions at mealtime may also help control symptoms. Eating meals at least 2 to 3 hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially. In addition, being overweight often worsens symptoms. Many overweight people find relief when they lose weight.

Avoid Cigarette smoking in Gastroesophageal reflux disease

Cigarette smoking weakens the lower esophageal sphincter. Stopping smoking is important to reduce Gastroesophageal reflux disease symptoms.

Change in sleeping way in Gastroesophageal reflux disease

Elevating the head of the bed on 6-inch blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimize reflux of stomach contents into the esophagus. Do not use pillows to prop yourself up; that only increases pressure on the stomach.

Use Antacids in Gastroesophageal reflux disease

Antacids be capable of help neutralize acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combine with a foaming agent helps some people. These compounds are supposed to form a foam barrier on top of the stomach that prevents acid reflux from occurring.

Side effects of Long-term use of antacids

Long-term utilize of antacids, however, can result in side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and buildup of magnesium in the body. Too much magnesium can be serious for patients with kidney disease. If antacids are needed for more than 2 weeks, a doctor should be consulted.

Medications to reduce acid in the stomach in chronic refluxes

For chronic reflux and heartburn, the doctor may recommend medications to reduce acid in the stomach. These medicines include H₂ blockers, which inhibit acid secretion in the stomach. H2 blockers include: cimetidine, famotidine, nizatidine, and ranitidine.

Another type of drug, the proton pump inhibitor (or acid pump), inhibits an enzyme (a protein in the acid-producing cells of the stomach) necessary for acid secretion. Some proton pump inhibitors include esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole, dexlansoprazole and omeprazole/ sodium bicarbonate.

 What do if Heartburn or Gastroesophageal reflux disease Symptoms Persist for longer time?

People with severe, chronic esophageal reflux or with symptoms not relieved by the treatments described above may need more complete diagnostic evaluation. Doctors use a variety of tests and procedures to examine a patient with chronic heartburn.

Endoscopy for individuals with chronic Gastroesophageal reflux disease

Endoscopy is a necessary way for individuals with chronic Gastroesophageal reflux disease. By keeping a small lighted tube with a tiny video camera on the end (endoscope) into the esophagus, the doctor may see inflammation and irritation of the tissue lining the esophagus (esophagitis). If the findings of the endoscopy are abnormal or questionable, biopsy (removing a small sample of tissue) from the lining of the esophagus can be helpful.

An upper GI series may be performed during the early phase of testing. This test is a special X-ray that shows the esophagus, stomach, and duodenum (the upper part of the small intestine). While an upper GI series provides limited information about possible reflux, it is used to help rule out other diagnoses, such as peptic ulcers.

Esophageal manometric and impedance studies

Esophageal manometric and impedance studies -- pressure measurement of the esophagus -- occasionally help to recognize low pressure in the lower esophageal sphincter or abnormalities in esophageal muscles contraction.

For patients whose diagnosis is difficult, doctors may check the acid levels inside the esophagus by pH testing. Testing pH monitors the acidity level of the esophagus and symptoms during meals, activity, and sleep. 

Need of Surgery in Gastroesophageal reflux disease

A few people with Gastroesophageal reflux disease may require surgery because of severe reflux and poor response to medical treatment. However, surgery should not be considered until all other measures have been tried. Fundoplication is a surgical procedure that increases pressure in the lower esophagus. Endoscopic procedures that involve making the lower esophageal sphincter function better or using electrodes to promote scarring of the lower esophageal sphincter are newer options in treatment.

Long-Term complications of Gastroesophageal reflux disease?

Sometimes Gastroesophageal reflux disease may become serious complications. Esophagitis can happen as a result of too much stomach acid in the esophagus. Esophagitis may creats esophageal bleeding or ulcers. In addition, a narrowing or stricture of the esophagus may occur from chronic scarring. Some people develop a condition known as Barrett's esophagus. This condition can increase the risk of esophageal cancer.

Gastroesophageal reflux disease (acid reflux) tests

Esophageal acid testing for Gastroesophageal reflux disease

Esophageal acid testing is considered a main test for diagnosing Gastroesophageal reflux disease. The amount of time that the esophagus contains acid is determined by a test called a 24-hour esophageal pH test. (pH is a mathematical way of expressing the amount of acidity.) For this test, a small tube (catheter) is passed through the nose and positioned in the esophagus. On the tip of the catheter is a sensor that senses acid. The other end of the catheter exits from the nose, wraps back over the ear, and travels down to the waist, where it is attached to a recorder. Each time acid refluxes back into the esophagus from the stomach, it stimulates the sensor and the recorder records the episode of reflux. After a 20 to 24 hour period of time, the catheter is removed and the record of reflux from the recorder is analyzed.

Problems with using pH testing for diagnosing Gastroesophageal reflux disease

There are problems with using pH testing for diagnosing Gastroesophageal reflux disease. Despite the fact that normal individuals and patients with Gastroesophageal reflux disease can be separated fairly well on the basis of pH studies, the separation is not perfect. Therefore, some patients with Gastroesophageal reflux disease will have normal amounts of acid reflux and some patients without Gastroesophageal reflux disease will have abnormal amounts of acid reflux. 

Capsule-Newer Method for measurement of acid exposure in the esophagus

A newer method for prolonged measurement (48 hours) of acid exposure in the esophagus utilizes a small, wireless capsule that is attached to the esophagus just above the lower esophageal sphincter. The capsule is passed to the lower esophagus by a tube inserted through either the mouth or the nose. After the capsule is attached to the esophagus, the tube is removed. The capsule measures the acid refluxing into the esophagus and transmits this information to a receiver that is worn at the waist. After the study, usually after 48 hours, the information from the receiver is downloaded into a computer and analyzed. The capsule falls off of the esophagus after 3-5 days and is passed in the stool. (The capsule is not reused.)

Advantages of capsule over standard pH testing for Gastroesophageal reflux disease

The advantage of the capsule over standard pH testing is that there is no discomfort from a catheter that passes through the throat and nose. Moreover, with the capsule, patients look normal (they don't have a catheter protruding from their noses) and are more likely to go about their daily activities, for example, go to work, without feeling self-conscious. Because the capsule records for a longer period than the catheter (48 versus 24 hours), more data on acid reflux and symptoms are obtained. 

Disadvantages of capsule over standard pH testing for Gastroesophageal reflux disease

Capsule pH testing is expensive. Sometimes the capsule does not attach to the esophagus or falls off prematurely. For periods of time the receiver may not receive signals from the capsule, and some of the information about reflux of acid may be lost. Occasionally there is pain with swallowing after the capsule has been placed, and the capsule may need to be removed endoscopically. 

Esophageal motility testing Gastroesophageal reflux disease

Esophageal motility testing determines how well the muscles of the esophagus are working. For motility testing, a thin tube (catheter) is passed through a nostril, down the back of the throat, and into the esophagus. On the part of the catheter that is inside the esophagus are sensors that sense pressure. A pressure is generated within the esophagus that is detected by the sensors on the catheter when the muscle of the esophagus contracts. The end of the catheter that protrudes from the nostril is attached to a recorder that records the pressure. During the test, the pressure at rest and the relaxation of the lower esophageal sphincter are evaluated.

Motility testing can identify some of these abnormalities and lead to a diagnosis of an esophageal motility disorder. The second use is evaluation prior to surgical or endoscopic treatment for Gastroesophageal reflux disease. 

Gastric emptying studies for Gastroesophageal reflux disease

Gastric emptying studies are studies with the purpose of determine how well food empties from the stomach. As discussed above, about 20 % of patients with Gastroesophageal reflux disease have slow emptying of the stomach that may be result to the reflux of acid. For gastric emptying studies, the patient eats a meal that is label with a radioactive substance. A sensor that is similar to a Geiger counter is placed over the stomach to measure how quickly the radioactive substance in the meal empties from the stomach.

Information from the emptying study can be useful for patients with Gastroesophageal reflux disease. For example, if a patient with Gastroesophageal reflux disease continues to have symptoms despite treatment with the usual medications, doctors might prescribe other medications that speed-up emptying of the stomach.

Symptoms of nausea, vomiting, and regurgitation may be due either to abnormal gastric emptying or Gastroesophageal reflux disease. An evaluation of gastric emptying, therefore, may be useful in identifying patients whose symptoms are due to abnormal emptying of the stomach rather than to Gastroesophageal reflux disease.

Acid perfusion test for Gastroesophageal reflux disease

The acid perfusion (Bernstein) test is used to determine if chest pain is caused by acid reflux. For the acid perfusion test, a thin tube is passed through one nostril, down the back of the throat, and into the middle of the esophagus. A dilute, acid solution and a physiologic salt solution (similar to the fluid that bathes the body's cells) are alternately poured (perfused) through the catheter and into the esophagus. The patient is unaware of which solution is being infused. If the perfusion with acid provokes the patient's usual pain and perfusion of the salt solution produces no pain, it is likely that the patient's pain is caused by acid reflux.

The acid perfusion test, however, is used only rarely. A better test for correlating pain and acid reflux is a 24-hour esophageal pH or pH capsule study during which patients note when they are having pain. 

Medication use for Gastroesophageal reflux disease

Proton pump inhibitors

The second type of drug developed specifically for acid-related diseases, such as Gastroesophageal reflux disease, was a proton pump inhibitor, specifically, omeprazole. A proton pump inhibitor blocks the secretion of acid into the stomach by the acid-secreting cells. The advantage of a proton pump inhibitor over an H₂ antagonist is that the proton pump inhibitor shuts off acid production more completely and for a longer period of time. Not only is the proton pump inhibitor good for treating the symptom of heartburn, but it also is good for protecting the esophagus from acid so that esophageal inflammation can heal.

proton pump inhibitors are used when H₂ antagonists do not relieve symptoms adequately or when complications of Gastroesophageal reflux disease such as erosions or ulcers, strictures, or Barrett's esophagus exist. Five different proton pump inhibitors are approved for the treatment of Gastroesophageal reflux disease, including omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole, and dexlansoprazole. A sixth proton pump inhibitor product consists of a combination of omeprazole and sodium bicarbonate. proton pump inhibitors (except for Zegarid) are best taken an hour before meals. The reason for this timing is that the proton pump inhibitors work best when the stomach is most actively producing acid, which occurs after meals. If the proton pump inhibitor is taken before the meal, it is at peak levels in the body after the meal when the acid is being made.

Pro-motility drugs in Gastroesophageal reflux disease

Pro-motility drugs work by stimulating the muscles of the gastrointestinal tract, including the esophagus, stomach, small intestine, and/or colon. One pro-motility drug, metoclopramide, is approved for Gastroesophageal reflux disease. Pro-motility drugs increase the pressure in the lower esophageal sphincter and strengthen the contractions (peristalsis) of the esophagus. Both effects would be expected to reduce reflux of acid. However, these effects on the sphincter and esophagus are small. Therefore, it is believed that the primary effect of metoclopramide may be to speed up emptying of the stomach, which also would be expected to reduce reflux.

Pro-motility drugs are most effective when taken 30 minutes before meals and again at bedtime. They are not very effective for treating either the symptoms or complications of Gastroesophageal reflux disease. Therefore, the pro-motility agents are reserved either for patients who do not respond to other treatments or are added to enhance other treatments for Gastroesophageal reflux disease.

Foam barriers in Gastroesophageal reflux disease

Foam barriers give a unique form of treatment for Gastroesophageal reflux disease. Foam barriers are tablets that contain an antacid and a foaming agent. As the tablet disintegrates and reaches the stomach, it turns into foam that floats on the top of the liquid contents of the stomach. The foam form a physical barrier to the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes into contact with the foam. The tablets are best taken after meals and when lying down, both times when reflux is more likely to occur. Foam barriers are not often used as the first or only treatment for Gastroesophageal reflux disease. Rather, they are added to other drugs for Gastroesophageal reflux disease when the other drugs are not alone effective in relieving symptoms. There is only one foam barrier, which is a combination of aluminum hydroxide gel, magnesium trisilicate, and alginate.

Antiulcer agents

Peptic ulcer is a broad term for an ulcer that occurs in the esophagus, stomach, or duodenum within the upper gastrointestinal (GI) tract. Ulcers are more specifically named according to the site of involvement: esophageal, gastric, or duodenal. Duodenal ulcers occur 10 times more frequently than gastric and esophageal ulcers. The release of hydrochloric acid (HCl) from the parietal cells of the stomach is influenced by histamine, gastrin, and acetylcholine. Peptic ulcers occur when there is a hypersecretion of hydrochloric acid and pepsin, which erode the GI mucosal lining.

Antacid V/S Acid Inhibitors

Effect of pH on gastric secretion

The gastric secretions in the stomach strive to maintain a pH of 2 to 5. Pepsin, a digestive enzyme, is activated at a pH of 2, and the acid-pepsin complex of gastric secretions can cause mucosal damage. If the pH of gastric secretions increases to 5, the activity of pepsin declines. 

The gastric mucosal barrier

The gastric mucosal barrier is a thick, viscous, mucous material that provides a barrier between the mucosal lining and acidic gastric secretions. The gastric mucosal barrier maintains the integrity of the gastric mucosal lining and is a defense against corrosive substances. The two sphincter muscles—the cardiac, located at the upper portion of the stomach, and the pyloric, located at the lower portion of the stomach—act as barriers to prevent reflux of acid into the esophagus and duodenum. 

Causes of esophageal ulcer

An esophageal ulcer results from reflux of acidic gastric secretions into the esophagus as a result of a defective or incompetent cardiac sphincter. A gastric ulcer frequently occurs because of a breakdown of the gastric mucosal barrier. 

Causes of Duodenal Ulcer

A duodenal ulcer is caused by hypersecretion of acid from the stomach passing into the duodenum because of (1) insufficient buffers to neutralize gastric acid in the stomach, (2) a defective or incompetent pyloric sphincter, or (3) hypermotility of the stomach. Gastroesophageal reflux disease (GERD) is inflammation or erosion of the esophageal mucosa caused by a reflux of gastric acid content from the stomach into the esophagus.

Classification of Antiulcer agents

1.     Tranquilizers, which decrease vagal activity.

2.     Anticholinergics, which decrease acetylcholine by blocking the cholinergic receptors.

3.     Antacids, which neutralize gastric acid.

4.     H₂ blockers, which block the H2 receptor.

5.     PPIs, which inhibit gastric acid secretion, regardless of acetylcholine or histamine release;

6.     The pepsin inhibitor sucralfate. 

7.     The prostaglandin E1 analogue misoprostol, which inhibits gastric acid secretion and protects the mucosa.

Currently, tranquilizers and anticholinergics are used infrequently due to potential adverse effects and much more effective drugs on the market. 

Tranquilizers use in treatment of Ulcer

Tranquilizers have minimal effect in preventing and treating ulcers; however, they reduce vagal stimulation and decrease anxiety. A combination of the anxiolytic chlordiazepoxide and the anticholinergic clidinium bromide may be used in the treatment of ulcers. Adverse effects may include edema, ataxia, confusion, extrapyramidal syndrome (EPS), and agranulocytosis.

Anticholinergics use in treatment of Ulcer

Anticholinergics (antimuscarinics, parasympatholytics) and antacids were the drugs of choice for peptic ulcers for many years. However, anticholinergic use declined with the introduction of H2 blockers in 1975. These drugs relieve pain by decreasing GI motility and secretion. They act by inhibiting acetylcholine and blocking histamine and hydrochloric acid. Anticholinergics delay gastric emptying time, so they are used more frequently for duodenal ulcers than for gastric ulcers. The anticholinergic propantheline bromide inhibits gastric secretions in the treatment of peptic ulcers.

Anticholinergics should be taken before meals to decrease the acid secretion that occurs with eating. Antacids can slow the absorption of anticholinergics and therefore should be taken 2 hours after anticholinergic administration.

Antacids

Antacid are drugs used to neutralize the hydrochloric acid secreted in the stomach in the gastric juice. They raise the pH of the gastric contents to above 3.5 and give symptomatic relief of pain (in gastric and duodenal ulcers) by lowering the acidity and consequently relieving the muscle spasm. They do this by acting as weak bases.

Ideal Properties of Antacids

An ideal antacid should not have any side effects other than its main action of neutralizing gastric acid. For example it should not have a constipating or Laxative effect. It should not cause, if absorbed, systemic alkalosis (in this condition the pH of the body fluids and tissues is high). It should not cause precipitation of phosphate I the gastrointestinal tract and depletion of phosphorus in the body. It should not also interfere with the absorption of other drugs such as tetracycline from the gut. It should not also delay the absorption of drugs which are weak acids or speed up the absorption of basic drugs. This happens when the pH of the gastric contents is raised.

Acid neutralizing capacity of Antacids

In the case of antacids, the acid neutralizing capacity is important. This may be determained by allowing the antacid to remain in contact with 0.1M hydrochloric acid at 37⁰C in a thermostatically controlled bath and measuring the pH at successive time intervals. Finally the concentration of the acid is out by determining the remaining acid by titration with 0.1M sodium hydroxide after one hour.

Classification of Antacids

Antacids are divided into:

      I.        Non-systemic Antacids: These, as stated above, directly neutralize the acid in the stomach and give relief in gastric and duodenal ulcers. The nonsystemic antacids are composed of alkaline salts such as aluminum (aluminum hydroxide) and magnesium (magnesium hydroxide, magnesium trisilicate). A small degree of systemic absorption occurs with these drugs, mainly of aluminum. Magnesium hydroxide has greater neutralizing power than aluminum hydroxide. Magnesium compounds can cause diarrhea, and aluminum and calcium compounds can cause constipation with long-term use. A combination of magnesium and aluminum salts neutralizes gastric acid without causing severe diarrhea or constipation. Simethicone, an antigas agent, is found in many antacids. 

1)    Aluminium hydroxide gel

2)    Dried aluminium hydroxide gel

3)    Aluminium phosphate

4)     Magnesium hydroxide

5)     Magnesium trisilicate

6)    Light and heavy magnesium carbonate

7)    Magaldrate

8)    Calcium carbonate.

9)    Bismulth suberarbonate

      I.        Systemic Antacids: These may be absorbed from the gut into the blood circulation and cause alkalosis. So they may also called as systemic alkalisers when they are used by injection to relieve acidosis in the blood, especially in diabetic coma. Sodium bicarbonate, a systemically absorbed antacid, was one of the first antiulcer drugs. Because it has many side effects (sodium excess, causing hypernatremia and water retention; metabolic alkalosis caused by excess bicarbonate; and acid rebound [excess acid secretion]), sodium bicarbonate is seldom used to treat peptic ulcers.

Calcium carbonate is most effective in neutralizing acid; however, one third to one half of the drug can be systemically absorbed and can cause acid rebound. Hypercalcemia and Burnett syndrome, formerly called milk-alkali syndrome, can result from excessive use of calcium carbonate. Burnett syndrome is intensified if milk products are ingested with calcium carbonate. It is identified by the presence of alkalosis, hypercalcemia, and in severe cases, by crystalluria and renal failure.

1)     Sodium bicarbonate

2)    Potassium citrate 

Combinations of Antacids

There are three complication usually seen when antacids are used. First, many antacids exert an action on the bowel. For example some have a mild laxative effect (eg. Magnesium hydroxide) and some are constipating (e.g. aluminum hydroxide).secondly if the cation (the metallic ion) is absorbed, systemic alkalosis (a condition in which the alkalinity of body fluids and tissues is abnormally high) may be produced (eg.sodium bicarbonate) Calcium ions may produce hupercalcaemia (the presence in the blood of an abnormally high concentration of calcium). (Magnesium and aluminum cause precipitation of phosphate in the gastrointestinal tract and depletion of phosphorus. Finally antacids may affect the absorption of other drugs which may be administered alon with antacids such as antichlolinergics and antibiotics. These drugs may be absorbed by the antacids. Antacids may also alter the pH of gut gastric contents thereby delaying the absorption of weak acids and speeding the absorption of basic drugs.

Drugs use to treat Indigestion or Dyspepsia

If dyspepsia (indigestion) leading to gas formation in the gut is present, use of a drug like methylpolysiloxane (dimethicone or simethicone) is necessary. It is apparent that it is wiser to make use of a combination of antacids so that the defect can be minimize. For example magnesium hydroxide and aluminium hydroxide may be collective to balance the constipating effect of the latter with the laxative effect of the former. On this basis the following combinations are in regular clinical use.

Combinations of Antacids List

1)    Magnesium and aluminium hydroxides (Magaldrate)

2)     Magensium and aluminium hydroxides, dimethicone (Dioval Forte Tabs)

3)    Magnesium and aluminium hydroxides,methylpolysiloxane (Gelusil MPS)

4)    Aluminium hydroxide gel, magnesium trisilicate (Gelusil)

5)    Aluminium hydroxide gel, Magnesium hydroxide, magnesium trisilicate (Gelusil M)

6)     Mag.hydroxide, dried alu, hydroxide gel, methylpolysiloxane, sod. Carboxymethyl cellulose (Digene gel).