Prior to prescription medications to control stomach
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Historical Approaches to Stomach Disorders Before Prescription Medications
Traditional Stomachics and Herbal Remedies
Myrobalan-Based Compounds and Electuaries
Before the advent of modern prescription medications, various traditional remedies were employed to manage stomach disorders. Arabic texts, for instance, describe the use of stomachics, myrobalan-based compounds, and electuaries to treat conditions such as severe coldness of the stomach, acid belching, and poor digestion. These remedies were also used for more complex issues like phlegmatic and black-bilious fevers, coldness of the testicles, and abdominal disorders1. The preparation of these medicines was meticulously documented, highlighting the importance of precise formulation in traditional medicine.
Chinese Herbal Prescriptions
In traditional Chinese medicine, herbal prescriptions like si-jun-zi-tang (SJZT) and shen-ling-bai-zhu-san (SLBZS) were commonly used for their antacid effects. Studies have shown that these herbal decoctions possess significant gastric acid neutralizing properties, comparable to modern antacids like sodium bicarbonate and colloidal aluminum phosphate. These herbal remedies were effective in maintaining a consistent neutralization effect on artificial gastric acids, suggesting their potential utility in managing stomach acidity3.
Early Pharmaceutical Interventions
Controlled Release Formulations
With the development of pharmaceutical sciences, controlled release formulations like Oscorel, a non-steroidal anti-inflammatory drug (NSAID), were introduced. These formulations were particularly prescribed to patients with a history of gastrointestinal disturbances, aiming to reduce the risk of gastrointestinal toxicity associated with NSAIDs. Studies indicated that Oscorel was preferentially prescribed to patients with recognized risk factors for gastrointestinal issues, reflecting an early attempt to tailor medication to patient-specific needs2.
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors (PPIs) represent a significant advancement in the treatment of stomach acid-related disorders. PPIs are highly effective in reducing gastric acid secretion and are commonly prescribed for conditions like gastro-oesophageal reflux disease and peptic ulcers. However, the long-term use of PPIs has raised concerns about potential side effects, including the development of gastric pre-malignant lesions. Research has shown mixed results, with some studies indicating an increased risk of enterochromaffin-like (ECL) cell hyperplasia, although the clinical significance of this finding remains uncertain7.
Modern Challenges and Considerations
Opioid Prescriptions for Gastrointestinal Diseases
In recent years, the management of gastrointestinal diseases has also seen an increase in opioid prescriptions, particularly for conditions associated with chronic pain such as chronic pancreatitis and liver disease. Despite public health efforts to limit opioid use due to the ongoing opioid crisis, prescription rates for gastrointestinal conditions have continued to rise. This trend underscores the need for alternative pain management strategies and further clinical interventions to mitigate the risks associated with opioid use9.
Gastroretentive Drug Delivery Systems
Innovations in drug delivery systems have also played a crucial role in the treatment of stomach disorders. Gastroretentive drug delivery systems, designed to prolong the residence time of drugs in the stomach, are particularly beneficial for medications that are locally active in the stomach or have an absorption window in the upper small intestine. These systems include bioadhesive, size-increasing, and floating drug delivery mechanisms, each with its own set of advantages and limitations6.
Conclusion
The management of stomach disorders has evolved significantly from traditional herbal remedies to sophisticated pharmaceutical interventions. While early treatments focused on natural compounds and simple formulations, modern medicine has introduced advanced drug delivery systems and targeted therapies. However, the challenges of long-term medication use and the rise in opioid prescriptions highlight the ongoing need for careful consideration and innovation in the treatment of gastrointestinal diseases.
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Most relevant research papers on this topic
Chapter Ten. On The Prescription Of Stomachics, Myrobalan-Based Compounds, And Electuaries
Stomachics, myrobalan-based compounds, and electuaries are useful against severe coldness of the stomach, acid belching, doggish craving, phlegmatic and black-bilious fevers, coldness of the testicles, abdominal disorder, poor digestion, and weakness and coldness of
Channelling of controlled release formulation of ketoprofen (Oscorel) in patients with history of gastrointestinal problems.
Oscorel has been preferentially prescribed in patients with gastrointestinal risk factors, likely due to expectations and claims that it has a lower risk of gastrointestinal toxicity.
Observational StudyAntacid effects of Chinese herbal prescriptions assessed by a modified artificial stomach model.
SJZT and SLBZS show consistent antacid effects in the artificial stomach model, suggesting similar effects to active control drugs sodium bicarbonate and colloidal aluminum phosphate.
In Vitro StudyExperimental research with Benefiting stomach prescriptions expression of the revelant gene of the Precancerous of gastric cancer
Benefiting stomach prescriptions effectively improve chronic atrophic gastritis symptoms and adjust the expression of related genes P21 and P16, potentially benefiting patients with gastric cancer.
RCTGastroretentive drug delivery systems
Prolonged gastric residence time is beneficial for drugs with specific properties, such as those that are active in the stomach or have limited absorption in the upper small intestine.
Highly CitedLong-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions.
Long-term PPI use may not significantly increase the risk of developing gastric pre-malignant lesions, but long-term use may not be recommended for certain diseases.
Meta-Analysis
Very Rigorous JournalHighly CitedAcid-suppressing therapies and subsite-specific risk of stomach cancer
Moderate exposures to acid-suppressive drugs did not favor proximal tumor localisation, but these findings do not resolve potential contributions to gastric carcinogenesis overall.
Observational Study
Rigorous JournalIncreasing Rates of Opioid Prescriptions for Gastrointestinal Diseases in the United States.
Opioid prescription rates for gastrointestinal disease visits increased from 2006 to 2016, suggesting an inadequate response by providers managing gastrointestinal conditions.
Observational Study[Regularity of prescription medication of Xin'an Wang's internal medicine in treating stomach cramps based on data mining].
Xin'an Wang's internal medicine treats stomach cramps by prioritizing deoppilation, focusing on liver and spleen soothing, activating Qi, eliminating phlegm, and promoting blood circulation.
Observational Study