Gastrointestinal tract disorders, treatment

Utility Treatment of Upper Gastrointestinal Tract Disorders... 

Indications Treatment of gastrointestinal tract disorders caused... 

Low-dose methotrexate is used for treatment of rheumatoid arthritis despite side effects such as disorders of the gastrointestinal tract and the liver. Leflunomide is also approved for this indication, however, hepatoxicity limits its use as first option. 

In severe cases, or those refractory to treatment, truncal and limb weakness may be accompanied by involvement of masticatory, bulbar, and respiratory muscles. However the most life-threatening clinical manifestations are those affecting the gastrointestinal tract, since stomach ulceration can occur and death from perforation and peritonitis are not unknown. Medication with steroidal antiinflammatory agents is necessary but weakens the childrens resistance to infection, so that systemic spread of usually self-limiting disorders, such as candidiasis, may occasionally occur. 

In the periphery, 5-HT4 receptor mRNA is found in vascular smooth muscle. Newly developed drugs that activate 5-HT4 receptors are of interest for their potential in treating cardiac arrhythmia. The 5-HT4 receptor is also located on neurons of the alimentary tract, for example the myenteric plexus of the ileum, and on smooth muscle cells and secretory cells of the gastrointestinal tract, where they evoke secretions and the peristaltic reflex. 5-HT4 receptor agonists (e.g. cisapride, prucalopride, tegaserod) are used therapeutically in the treatment of constipation-predominant irritable bowel syndrome and in functional motility disorders of the upper gastrointestinal tract. 

The main limitation to the clinical use of the MAOIs is due to their interaction with amine-containing foods such as cheeses, red wine, beers (including non-alcoholic beers), fermented and processed meat products, yeast products, soya and some vegetables. Some proprietary medicines such as cold cures contain phenylpropanolamine, ephedrine, etc. and will also interact with MAOIs. Such an interaction (termed the "cheese effect"), is attributed to the dramatic rise in blood pressure due to the sudden release of noradrenaline from peripheral sympathetic terminals, an event due to the displacement of noradrenaline from its mtraneuronal vesicles by the primary amine (usually tyramine). Under normal circumstances, any dietary amines would be metabolized by MAO in the wall of the gastrointestinal tract, in the liver, platelets, etc. The occurrence of hypertensive crises, and occasionally strokes, therefore limited the use of the MAOIs, despite their proven clinical efficacy, to the treatment of atypical depression and occasionally panic disorder. 

Bromocriptine is a D2 agonist its structure is shown in Table 16-4. This drug has been widely used to treat Parkinson s disease and has also been used to treat certain endocrinologic disorders, especially hyperprolactinemia (see Chapter 37 Hypothalamic Pituitary Hormones), but in lower doses than for parkinsonism. Bromocriptine is absorbed to a variable extent from the gastrointestinal tract peak plasma levels are reached within 1-2 hours after an oral dose. It is excreted in the bile and feces. The usual daily dose of bromocriptine in the treatment of parkinsonism is between 7.5 and 30 mg, depending on response and tolerance. In order to minimize adverse effects, the dose is built up slowly over 2 or 3 months from a starting level of 1.25 mg twice daily after meals the daily dose is then increased by 2.5 mg every 2 weeks depending on the response or the development of adverse reactions. 

Owing to its poor solubility, as compared to mephenesin, its absorption through the gastrointestinal tract is rather slow, which is responsible for its longer onset and duration of action. It is employed in the treatment of muscle spasm caused by musculoskeletal disorders, tetanus and injury. 

Psychiatric A rare compulsive behaviour which is caused by levodopa treatment is trichotillomania, which is characterized by the compulsive urge to pull out one s own hair. Since patients often feel ashamed or actively attempt to disguise their symptoms, this hair-pulling disorder may appear in conjunction with trichophagia, which is characterized by eating hair, usually their own. Most often, hair is pulled out and then the ends of the root bulb are eaten, or occasionally the hair shaft itself. The hair can eventually collect in the gastrointestinal tract and can lead to a hair ball called trichobezoar. This situation may cause a problem in administer duodenal L-dopa-carbidopa gel [65 ]. 

Fruit preparations, calculated at a daily dose of20-60 g, are used for the treatment of acute diarrhea and for localized nuld inflammation of the mucous membranes of the mouth and throat. In Europe, leaf preparations are used for the supportive treatment of diabetes mel-htus prevention and treatment of gastrointestinal, kidney, and urinary tract disorders, as well as arthritis, dermatitis, functional heart problems, gout, hemorrhoids, poor circulation, and for metabolic stimulation of circulation. Efficacy of the leaves is not established and their therapeutic use is not recommended (blumenteial 1). 

Traditional Medicine. Both in domestic Western and Chinese medicine, dill seed and dill seed oil are used as aromatic carminative and stimulant in the treatment of flatulence, especially in children. Reported to have carminative, antispasmodic, sedative, lactago-gue, and diuretic properties. Used in India, Africa, and elsewhere for hemorrhoids, bronchial asthma, neuralgias, renal colic, dysuria, genital ulcers, dysmenorrhea, and others. In European tradition, dill herb is reportedly used as an antispasmodic for conditions of the gastrointestinal tract, kidney and urinary tract also for sleep disorders. ... 

Aside from their utility for the treatment of multiple skin manifestations, psoralens and UVA radiation could be used as a therapeutic alternative for several immune-mediated disorders as Crohn s disease and ulcerative colitis. Both are chronic inflammatory diseases of the gastrointestinal tract and are collectively known as inflammatory bowel disease. This disorder is produced by a dysfunction of the immtme system that leads to the accumulation of abtmdant lymphocytes and monocytes in the mucosa of the bowel, together with the secretion of cytokines and proinflammatory mediators. There are several genetic, environmental, and physiological factors that contribute to the pathogenesis of inflammatory bowel disease [151]. 

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