Your stomach is an amazing organ. It takes just about anything you throw at it, breaks it down and reroutes it through the proper channels for digestion, nutrient absorption, and toxin extraction. Once it’s squeezed out all it can from that sandwich you had for lunch, it kicks the leftover detritus out the back door.
We rely on this remarkably efficient machine every time we stuff something in our mouths, and we rarely think about it — until the machine sputters and it turns on us by stabbing, churning or burning. That’s when we reach for something to soothe the pain, quell the nausea or stop up the diarrhea. But what medication works best on what bellyache? We asked Bilal Hatoum, BSc. Pharm., a Calgary clinical, emergency department pharmacist, and Eric Lam, MD, FRCPC, clinical associate professor at UBC’s Division of Gastroenterology, for their gut reaction.
“Generalized stomach aches and symptoms are among the most common complaints in both community pharmacy and hospital emergency departments,” says Hatoum. “I work in both, so I see these on a daily basis. Assessing the exact cause is almost akin to the pharmacist playing detective and the patient giving as many clues as possible. Most importantly, we must always inquire about any red flags, meaning symptoms that warrant a physician referral asap, such as chest pain resembling heart attack, whether the pain intensity is moderate to severe, whether there is choking or trouble swallowing, stomach bleeding or vomiting blood, and unintentional weight loss. Many treatments focus on relieving symptoms rather than curing the disease, hence the importance of following up with a physician to determine the underlying cause of the problem.”
Minor and temporary tummy troubles, however, usually respond well to over-the-counter (OTC) medications such as the following.
Symptoms: Nausea and vomiting
Relief: Dimenhydrinate, a class of medications called antihistamines, such as Gravol and Dramamine
Course for correction: Two to three days
Possible side effects: Drowsiness, dry mouth, constipation, urinary retention, dizziness and blurred vision
How they work: Block the nerve impulses in the vomiting centre and gastrointestinal tract
Notes: “Always begin with non-drug measures first,” says Hatoum. “For example, eating smaller meals, avoiding spicy foods, maintaining adequate hydration with water and electrolytes.”
Dr. Lam adds that, although it’s not common because it’s not usually taken long enough, Gravol can be addicting in high doses and alongside certain other medications.
Symptoms: Acid indigestion (dyspepsia) and heartburn
Relief: Antacids such as Rolaids and Tums (calcium carbonate), Maalox (aluminum hydroxide and magnesium hydroxide), Gaviscon (aluminum hydroxide and magnesium carbonate), Pepcid AC (famotidine)
Course for correction: No more than two weeks
How they work: Rolaids, Tums and Pepcid AC neutralize stomach acid; Gaviscon creates a foam that floats on top of the stomach to prevent juices from backing up into the esophagus
Possible side effects: Calcium carbonate and aluminum can cause constipation; magnesium can cause diarrhea; famotidine can cause headache and dizziness
Notes: “Magnesium salts should be avoided in kidney disease and elderly people,” says Hatoum. “And those with high blood pressure, heart failure, kidney problems and pregnant women should avoid sodium bicarb.”
Dr. Lam adds, “Chronic heartburn could be mimicking something more serious, such as esophagitis (inflammation of the esophagus) or Barrett’s esophagus,” which could lead to esophageal cancer.
Symptoms: Abdominal cramping and pain
Relief: Anticholinergics and antispasmodics such as Buscopan (hyoscine butylbromide) and Bentyl (dicyclomine)
Course for correction: Three to four times a day as needed
How they work: Relax the muscle spasms in the abdomen
Possible side effects: Sedation, dry mouth, blurred vision, urinary retention, increased heart rate
Notes: “People with glaucoma, heart issues, prostate problems and the elderly at risk for falls should use caution with these medications,” says Hatoum.
Relief: Imodium and Kaopectate (loperamides), Pepto-Bismol (bismuth subsalicylate), Metamucil (psyllium)
Course for correction: Two days
How they work: Loperamides and bismuth subsalicylate decrease secretions of body fluid, and slow down the movement of the intestines. Psyllium absorbs liquid from your intestines, making the stool firmer and slowing passage through the colon
Possible side effects: Imodium can cause cramping, constipation and drowsiness, and can worsen nighttime pain, so it’s best to avoid it altogether in painless diarrhea. Avoid Pepto-Bismol if there’s a history of aspirin allergy, kidney problems, gout and stomach ulcers/bleeds. It can cause darkened or black tongue and stool, which is harmless. Use caution when combining with blood thinners and diabetes medication. Metamucil can cause cramping and gas (drink plenty of water throughout the day, leave two hours between other medications)
Notes: Diarrhea raises many red flags, says Hatoum, particularly if there is blood or abnormal mucous in the stool, severe cramping and pain, fever, if you’re pregnant, under two years old, or have diabetes
Says Dr. Lam, “Chronic diarrhea could mimic celiac disease, Crohn’s disease and ulcerative colitis. New onset diarrhea that does not improve with OTC medications in anyone over 40 should prompt investigations. In older people we are concerned about colon cancer.”
Symptoms: Flatulence, indigestion
Relief: Lactaid (lactase enzyme), Eno and Alka-Seltzer (simethicone), Beano (alpha-d-galactosidase)
Course for correction: Two tablets/packets every four hours; no more than eight doses in 24 hours
How they work: Lactase breaks down sugars in dairy products to make them easier to digest; simethicone prevents liquids from bubbling up in the stomach; Beano breaks down complex sugars in the digestive tract, reducing bloating and gas
Possible side effects: No documented side effects if taken on their own, but there is a possibility of serious allergic reaction to simethicones (which also contain high doses of sodium). “The biggest side effects are gastrointestinal bleeding with Alka-Seltzer/Eno,” says Dr. Lam, particularly if you’re taking other medications that contain acetylsalicylic acid (ASA), and blood thinners.
Notes: “Alka-Seltzer/Eno contain ASA, or aspirin, which if taken long term can lead to stomach ulceration,” says Dr. Lam. “Those with kidney problems should avoid ASA products and it should not be given to children because of [the risk of] Reye’s syndrome. The main danger to OTC medications is not that chronic usage will lead to damage to the body per se; it’s that people may be masking something more serious that the OTC would not have helped anyway. Usually, if patients are not responding to OTC treatment of any kind for two to three weeks, or if they find that they require higher or more frequent dosing, they should seek the advice of their primary care physician.”
Hatoum advises that, before relying on any of these meds, to first consider changes in diet and lifestyle, such as limiting carbonated and lactose food and drink, eating slowly and earlier in the day. Proper care and feeding of your amazing organ will keep it healthy and high functioning. Burp.