Drugs to improve digestion - ideal helpers for the stomach

N. A. Tsubanova, National Pharmaceutical University

One of the pressing problems of modern medicine and pharmacy remains the treatment of constipation. According to some data, constipation or functional bowel diseases have been considered the most common among gastroenterological patients in the last decade. This is confirmed by data from epidemiological studies cited by Prof. N.B. Gubergrits, where it is noted that constipation is diagnosed in 12% of the adult population of the Earth, 50% of the population of Great Britain, Russia, 30% of the population of Germany, 20% of the population of France. According to T.V. Borodina, N.D. Bunyatyan, this disease reaches 10% only among school-age children. And this is just the tip of the iceberg, considering that people suffering from constipation often do not consult a doctor, but self-medicate. According to foreign authors, about 75% of older people self-medicate for constipation. Given the above, it is not difficult to understand that the true prevalence of constipation is apparently much higher than what appears from epidemiological studies.

Constipation is defined as an increase in the intervals between bowel movements of more than 48 hours, and straining takes up more than 25% of the time of bowel movements. In chronic constipation, this condition occurs for more than three months. Constipation often involves irregular bowel movements, too hard stool consistency, a feeling of incomplete evacuation, or a small amount of stool (less than 35 g; normal 100–150). Constipation is caused by a disruption in the formation and movement of feces through the intestines. There may be several reasons: disorders of motor activity (motility) of the intestinal muscles, weakening of the urge to defecate, changes in the structure of the intestine or organs closest to it, preventing the normal movement of contents, a discrepancy between the capacity of the colon and the volume of intestinal contents. A problem in the pharmacotherapy of constipation is also the polyetiology of the disease (Table 1). First of all, these are endocrine and metabolic diseases, various neurogenic factors (autonomic dysfunction, which is a disorder in the activity of the autonomic part of the nervous system, regulating the functions of internal organs). Factors that cause constipation with the participation of nervous mechanisms also include reflex effects on the intestines from various organs, primarily the stomach and bile ducts. Diseases of the rectoanal zone occupy a significant place in the etiology of constipation.

How to understand when it's time to take enzymes

Overeating often leads to digestive disorders

If you begin to observe the work of your body and treat it with reverence, you can immediately notice the beginning changes that will indicate problems with the gastrointestinal tract. There are a number of manifestations that indicate that it is time to help the stomach:

• Constant fatigue, which appears due to the fact that the body does not receive the proper amount of vitamins and microelements that are so necessary for normal functioning. This is why the body gets more and more tired due to the use and depletion of its own reserves
• Constant drowsiness, which also occurs due to lack of nutrients
• Poor skin condition. It becomes dry and pigment spots may appear on it.
• Poor condition of hair and nails. These are some of the most alarming symptoms that the body lacks vitamins due to poorly digestible food.
• Intestinal problems, namely frequent constipation or diarrhea, flatulence, nausea
• Painful sensations in the abdomen, especially after eating
• Poor appetite, which appears due to discomfort in the stomach
• If a person has at least one of the above signs that problems with the gastrointestinal tract have begun, it is imperative to consult a doctor and start taking enzymes.

Colonoscopy – we relieve the consequences and restore the intestines

Such an informative study as a colonoscopy cannot be replaced by anything in terms of diagnosis. Unfortunately, this intervention in the internal environment of the human body does not pass without consequences. After this procedure, the person being examined may experience:

• intestinal bleeding,
• stomach ache,
• constipation,
• diarrhea,
• flatulence.

Most often, a special diet for recovery is not required; you can switch to a normal diet on the day of the examination. The problem with flatulence, which is explained by the air remaining in the intestines after the examination, is easily solved. It is enough to take 4-5 crushed tablets of activated carbon simultaneously with plenty of water.

Causes of digestive disorders

Sometimes stomach problems begin after a heavy dinner or, conversely, after hunger. But besides these reasons, there are others that are associated with food consumption:

1. Poor nutrition, namely abuse of smoked meats, pickles, fatty foods that are difficult to digest, as well as the presence of large quantities of sweets in the diet
2. Binge eating. Doctors say that you need to leave the table half-starved, because with this feeling it is impossible to overeat. Often, the stomach is already full, but this signal has not reached the brain, and therefore the person thinks that he wants to eat. If you eat food slowly, you can avoid overeating, which can cause digestive problems.
3. Poor chewing of food. Many people eat in a hurry and, because of this, chew food poorly, especially hard food. And it is much harder to digest
4. Dinner at a late time. Many people are used to eating after 9 pm, which is very bad not only for the stomach, but also for the whole body. The biological clock works in such a way that by the evening all processes slow down, and late meals can simply lead to indigestion
5. Drinking large amounts of water during meals. Almost all nutritionists recommend drinking a lot of water, but there is one caveat. This should be done exclusively between meals, as water dilutes the enzymes in the stomach and their action becomes less effective.

Everyone knows what causes digestive problems, but few people adhere to a healthy lifestyle, and with it, nutrition.

Drugs to improve digestion

Festal is one of the most popular drugs

If there is a malfunction in digestion, it can be improved only by following a diet and taking medications. All drugs can be divided into several groups, each of which differs in its main active ingredient and its effect:

• Preparations containing pancreatin as the main component. It is pancreatin that is the enzyme that can provide immediate support in case of digestive disorders. Such medications include Pancreatin, Mezim, Penzital, Creon
• Preparations that, in addition to pancreatin, contain other auxiliary components, such as hemicellulose, bile acids, etc. These components help break down complex sugar compounds, improve intestinal activity and the production of enzymes by the pancreas. The main drugs in this group include Festal, Enzistal, Panzinorm
• Drugs that help normalize the exocrine activity of the pancreas. Such drugs include Somilaza, Nigedaza, Oraza

Only a doctor can prescribe this or that drug after a thorough examination, since independent selection of medications will not always be correct. In some cases, it will be better to drink Festal than Pancreatin, as many do.

Table 2. Classification of laxatives (Zimmerman Ya. S., 1999)

In general terms, the mechanism of action of laxatives is presented in Table 3.

Forms of release of drugs

Not everyone knows that depending on how the drug is released, its immediate effect will depend. Today, all enzyme-based drugs are available in two forms:

1. Capsules. More recently, drugs began to be produced in capsules, and for some time people were afraid to purchase them until the results of the study were publicly published. So, each capsule has all the shells. The first dissolves in the stomach, and the second only in the intestines. Thus, the effect of the drug taken in capsule form extends to the entire gastrointestinal tract
2. Pills. It just so happens that consumers trust pills more. Their effect extends exclusively to the stomach, since under the influence of gastric juice it dissolves and is absorbed there.

The choice of the best form to take depends solely on the doctor and the patient. Some people, having purchased a capsule, for some reason open it and take only granules, thereby preventing the drug from penetrating the intestines. Under no circumstances should this be done with capsules. As for the tablets, they can be crushed, split into two parts, etc. This will not reduce the effect.

Table 1. Main causes of constipation (Zlatkina A. R., 2002)

Inhibition of intestinal motor function and the appearance of constipation, especially in elderly and old people, is facilitated by insufficient physical activity (physical inactivity). Special attention should be paid to medications that can cause constipation, especially with long-term use. This is inherent in atropine, various narcotic drugs, some anticonvulsants (diphenin), calcium bicarbonate (baking soda). Psychotropic drugs (tranquilizers, antidepressants), some diuretics, iron supplements, aluminum hydroxide (Almagel) can cause constipation. Depending on the etiology of constipation, there are: nutritional; conditioned reflex neurogenic (“habitual” neglect, situational constipation); functional (essential, primary, idiopathic) constipation (causes: irritable bowel syndrome, hypomotor dyskinesia of the colon, chronic idiopathic intestinal pseudo-obstruction); constipation associated with organic intestinal pathology (causes: neoplasms, diverticula, ischemia, stenosis); constipation associated with neuromuscular disorders of the intestines (multiple sclerosis, neuromatosis, systemic scleroderma, amyloidosis); constipation (dyschezia) associated with pathology of the rectal and anal area (fissures, fistulas, enteroceles, rectoceles, abscesses, strictures, viral or syphilitic condylomas); symptomatic constipation; with endocrine pathology (diabetes mellitus, hypothyroidism); for neurological pathology (Parkinson's disease, spinal cord injury, organic pathology of the central nervous system); constipation associated with inflammation of the urogenital organs; drug-induced constipation (taking psychotropic drugs, clonidine, calcium antagonists, narcotic analgesics, anticholinergics, antidepressants, tranquilizers and antiparkinsonian drugs, non-steroidal anti-inflammatory drugs, antacids, tricyclic antidepressants, iron supplements, sympathomimetics, bismuth preparations, lithium preparations, barbiturates, phenothiazines, diuretics, barium sulfate). In clinical practice, a classification of constipation according to its course is accepted: acute and chronic. In acute constipation, there is a sudden absence of stool for more than two days. The most common causes of acute constipation are: intestinal obstruction (tumors, inflammation, diverticulitis), pathology of the anorectal region, acute cerebrovascular accident, traumatic brain injury, bed rest and side effects of medications. Sudden onset of constipation requires the exclusion of a neoplasm in the left half of the colon. Constipation, which is based on inflammatory processes, is characterized by the presence of fever, and constipation associated with a neoplasm is characterized by a gradual increase in clinical symptoms and lengthening of the intervals between bowel movements. In patients with chronic constipation, dysbiosis must be excluded. In patients suffering from constipation due to decreased intestinal motor function, as a rule, it is necessary to exclude organic pathology of the gastrointestinal tract (gastritis, duodenitis, peptic ulcer). Chronic constipation can cause various complications: secondary colitis, proctosigmoiditis (inflammation of the sigmoid and rectum). With prolonged stagnation of contents in the cecum, it may be thrown back into the small intestine with the development of enteritis (reflux enteritis). Constipation can be complicated by diseases of the biliary tract, hepatitis, and contribute to the appearance of various diseases of the rectum. The most common occurrence is hemorrhoids. With constipation, rectal cracks and inflammation of the peri-rectal tissue (paraproctitis) can also occur. Long-term constipation sometimes causes the colon to expand and lengthen (acquired megacolon), which makes it even more persistent. The most dangerous complication of long-term constipation is cancer of the rectum and colon. Stagnation of contents in the intestines, caused by the consumption of foods poor in dietary fiber, leads to a high concentration of carcinogenic (cancer-promoting) substances formed in the intestines and their long-term effect on the intestinal wall. The basis of treatment for constipation is to eliminate its cause, and the use of laxatives is auxiliary. Prescribing a laxative without identifying the cause of constipation is unacceptable. The choice of therapeutic tactics is also determined by the cause of constipation. Nutritional constipation requires nutritional correction. If constipation occurs on the road or at a time when it is difficult to eat regularly, you should take a laxative for a short time. Constipation, especially if it occurs when moving or on business trips, can also go away when taking eubiotics (Bifikol, Acylact, Bufidumbacterin, etc.). The only type of laxative allowed for self-medication is laxatives that help increase the volume of intestinal contents, such as seaweed, oatmeal, bananas, agar-agar, lactulose. But even their reception should be episodic. Laxatives that help increase the volume of intestinal contents usually begin to act after a time interval of 12 hours to 3 days. For patients suffering from constipation, the dietary fiber content of foods should be taken into account. With a large amount of coarse fiber in food, people with complaints of bloating produce on average 2 times more gases than with a diet with moderate fiber content, and almost 5 times more than with a liquid, chemically homogeneous diet without dietary fiber. Patients with constipation and complaints of bloating should limit or even exclude foods rich in dietary fiber from their diet. Avoid dishes made from beans, cabbage, sorrel, spinach, etc., which cause increased gas formation. Apple and grape juices are not recommended. If there are no special contraindications (heart disease, edema), then a patient suffering from constipation should drink approximately 1.5–2 liters of fluid per day. Taking enough fluid is very useful, since due to the slow evacuation of feces from the intestines, they dry out, which, in turn, makes it difficult for them to move through the colon. It is important to maintain a proper diet. Food must be taken at least 5 times a day. Long breaks between meals are unacceptable. Bran provides a very significant therapeutic effect for constipation. They are resistant to the action of digestive juices, are not a significant source of energy and at the same time stimulate the evacuation function of the intestines to a greater extent. A rather difficult problem in the treatment of constipation is the use of laxatives. They are very effective at first, but with prolonged use, addiction is possible, accompanied by a complete loss of the independent urge to defecate. Laxatives are contraindicated for constipation of nutritional origin. The use of laxatives should be differentiated depending on the etiology and pathogenesis of constipation. The most complete classification of laxatives today can be considered (Y. S. Zimmerman, 1999) [4, 13], given in Table 2.

Pancreatin

Creon. Release form - tablets

Pancreatin is one of the best drugs for improving digestion. In addition, the price of Pancreatin is quite low. So, a pack of 60 tablets can be bought for 70 rubles. This drug is indicated for use in several cases:

Creon

Most gastroenterologists recommend taking Creon, as it is available in capsule form. As mentioned above, the effectiveness of capsules is much higher, since the drug penetrates not only the stomach, but also the intestines. The main active ingredient in Creon is pancreatin, which very well stimulates the production of all necessary enzymes. It is prescribed during treatment:

• Chronic pancreatitis
• After operations performed on the gastrointestinal tract
• Cystic fibrosis
• Oncological diseases, namely tumors formed in the immediate vicinity of the stomach and pancreas, thereby interfering with their normal functioning
• Creon is also recommended to be taken during a large meal (at corporate parties, holidays, etc.) in order to improve digestion and prevent the occurrence of indigestion.

It is recommended to take one capsule before each meal. It is advisable to simply drink it with water and not chew it, so that the drug enters not only the stomach, but also the intestines. Separately, it is necessary to say about side effects. The drug does not have them as such, but as regards the reaction of the gastrointestinal tract, diarrhea may develop and pain in the stomach area will appear. Some patients develop hives. Usually this is the body’s reaction not to pancreatin, but to the auxiliary components of the medicine.

Creon is one of the drugs that can improve digestion. True, it is considered much stronger than Pancreatin, and therefore can only be taken after a doctor’s prescription.

Table 3. Classification of laxatives by mechanism of action

* Bisacodyl has a laxative effect several hours after ingestion and within an hour when used as rectal suppositories. Dragees contain 0.005 g of active substance, suppositories - 0.01 g. Prescribe 1-3 pills or a suppository per day. In addition to the secretory effect, bisacodyl also affects colon motility. When used in suppositories, it significantly increases the propulsive contractile activity of the colon. ** Lactulose is not broken down in the small intestine and enters the large intestine unchanged. In contrast, in the colon, lactulose is broken down by intestinal flora. The breakdown products of lactulose have a stimulating effect on colon peristalsis, stool softens, and in addition, its volume increases. Currently, more than 200 dosage forms of laxatives are registered on the Ukrainian pharmaceutical market. The top five includes various drugs based on bisacodyl - 44 items; glycerol - 25; Vaseline - 23; drugs based on sennosides - 19; castor oil - 18; they are followed by drugs based on buckthorn, lactulose, etc. It is impossible to talk about a significant variety of laxative drugs on the pharmaceutical market. Basically, as you can see, the same medicinal substances from different manufacturing companies are presented. Let's look at these drugs in more detail. Motor regulators include antispasmodics and prokinetics. Traditionally prescribed myotropic antispasmodics such as papaverine, drotaverine, mebeverine, pinaverium bromide do not eliminate constipation [6]. In recent years, 5-HT4 serotonin receptor agonists have been introduced into practice. Serotonin, released by enterochromophin cells of the intestine, stimulates vagal and enteric afferent nerve fibers, increases the release of acetylcholine, enhances smooth muscle contraction and, thus, normalizes passage. Drugs in this group include tegaserod and cisapride, the latter was withdrawn from the market due to serious side effects (heart rhythm disturbances, extrapyramidal disorders). Prokinetics should not be taken without a doctor's prescription. The effect of taking them begins from the second week of treatment and, what is especially important, can persist for several months after completion of the course of treatment. For spastic dyskinesia, myotropic antispasmodics or M-anticholinergic blockers are included in the treatment complex. New drugs have shown high effectiveness in this condition, as well as in irritable bowel syndrome: pinaverium bromide (Dicetel) and otilonium bromide (Smazmomen). The use of drugs with a high content of bile acids (allochol, lyobil, henofalk) is justified in cases where hypofunction of the gallbladder is diagnosed. Recently, the most physiological corrector of bile formation processes seems to be odeston (1-2 tablets 3 times a day). Constipation caused by acute inflammatory bowel diseases, anorectal fissures and hemorrhoids can be eliminated by treating these diseases, as they cause sphincter spasm. In these cases, the prescription of laxatives is ineffective. For constipation during pregnancy, the drugs of choice are representatives of the group of osmotic laxatives: the synthetic disaccharide lactulose and the stool regulator macrogol. Laxatives that stimulate intestinal motility are contraindicated, as they can cause miscarriage and premature birth. Lactulose is a synthetic disaccharide that, after ingestion, is not destroyed by disaccharidase in the small intestine, is not absorbed in the small intestine, and reaches the colon, where, during bacterial decomposition, it breaks down into short-chain fatty acids (lactic, acetic, propionic and butyric). This lowers the pH of the colon contents and stimulates peristalsis. Due to an increase in the volume of feces (fluid influx), a reflex contraction of the intestine occurs - the act of defecation occurs physiologically. Lactulose helps reduce the growth of ammonium-producing bacteria and thereby reduces the flow of ammonia into the blood. Acidification of the colon leads to the death of pathogenic microflora and the proliferation of beneficial ones. Lactulose is often indispensable in the treatment of constipation refractory to other laxatives. Lactulose is effective in the treatment of chronic constipation, hepatitis, liver failure, hepatic coma, hepatic encephalopathy, liver cirrhosis, hyperazotemia, salmonellosis, dysbacteriosis. The drug has been proven to be highly effective in elderly people, after gynecological operations, and for constipation due to adhesions and radiation damage to the intestines. Lactulose is one of the most effective prebiotics, as it selectively stimulates the growth of bifidobacteria and lactobacilli. Therefore, lactulose is successfully used for intestinal dysbiosis, especially in combination with probiotics containing live strains of bifidobacteria and lactobacilli. Lactulose preparations can be prescribed to infants, as well as pregnant and lactating women. Lactulose does not reduce the absorption of vitamins and is not addictive. Macrogol acts throughout the intestine. It causes an increase in the volume of intestinal contents and its softening due to the formation of additional hydrogen bonds with water molecules, its retention and accumulation in the intestinal lumen, increasing intracellular osmatic pressure. Due to its high molecular weight, macrogol is not absorbed, is not metabolized in the gastrointestinal tract and does not affect the normal intestinal microflora, does not remove vitamins and salts from the body and does not irritate the intestinal mucosa. In foreign literature, this drug is classified as a new group of laxatives - stool regulators. Macrogol is not intended for a single dose to achieve defecation, but for the systematic and gradual restoration of normal bowel function and regular bowel movements. Macrogol causes painless bowel movements at the patient’s usual time. Macrogol is recommended for constipation, especially in older people, patients with diabetes, hypertension, renal and liver failure, and cardiovascular diseases. Stool softeners: petroleum jelly (liquid paraffin), almond and castor oil, sodium docusate. Oil-based laxatives not only soften feces, but also speed up the passage of small intestinal contents and reduce fluid absorption. Castor oil stimulates peristalsis most strongly. The effect of taking it occurs within 2–3 hours. Currently, the use of this group of laxatives is limited, as they cause nausea, can be involuntarily released from the anus (vaseline oil) and significantly increase the risk of developing malignant neoplasms of the gastrointestinal tract; may be partially absorbed; reduce fluid absorption and accelerate its passage. Stimulators of intestinal motility. Saline laxatives (inorganic salts: phosphates, magnesia, Glauber's salt). Saline laxatives act throughout the intestines, which allows them to be used in the treatment of food poisoning to remove toxins. The general properties of saline laxatives are insignificant absorption from the intestine and the need for their use in the form of a hypertonic solution. Stimulants and saline laxatives should be taken in the morning. Their disadvantages: cause nausea; are absorbed into the systemic circulation, which can lead to systemic side effects; the laxative effect is uncontrollable and unpredictable, and therefore there is a high risk of dehydration; contraindicated in children and chronic renal failure. Drugs that increase the volume of intestinal contents: herbal laxatives (bran, seaweed), indigestible fibers (methylcellulose, agar). Mechanism of action: due to the hydrophilic or osmotic properties of drugs in this group, fluid is retained in the intestinal lumen, an increase in volume and softening of the chyme, which leads to an improvement in its passage in the intestine against the background of enhanced peristalsis. Containing anthranoids: preparations of buckthorn, senna, rhubarb, pursenide, tisasen, regulax. Mechanism of action: irritate the colon mucosa or directly stimulate the submucosal (mesenteric) nerve plexuses and smooth muscles. To realize their action, sufficient activity of bacterial sulfatase is necessary, ensuring the transition of anthranoids into anthrones. Strengthen intestinal motility and increase the volume of fluid in the intestines. Anthraquinones are the most common laxatives, as they are found in buckthorn, rhubarb, senna and are part of many combined herbal remedies. Drugs in this group act at the level of the colon and stimulate smooth muscles, accelerate the transport of water into the intestinal lumen and inhibit the thickening of feces (antiabsorption and hydrogonal effects, respectively). With long-term (many months) use, anthraquinones can cause the development of intestinal pseudomelanosis. It is currently believed that laxatives in this group are used unreasonably widely and for an unreasonably long time. The use of laxatives containing herbal components is associated with certain difficulties, since the content of their main active principle - anthraglycosides - is subject to fluctuations, which leads to fluctuations in their activity. Senna preparations may turn urine red or brown. To herbal laxatives, addiction develops most quickly. Disadvantages of intestinal motility stimulants containing anthranoids: antiabsorption and hydrogonal action; mutagenic effect; ability to cause intestinal melanosis; development of post-laxative intestine; addiction; the occurrence of cracks and lacunae in the intestinal mucosa; perianal thrombosis; with long-term use, they increase the risk of developing colon tumors; absorbed into the bloodstream and excreted through the kidneys. Preparations that do not contain anthranoids: diphenylmethane derivatives (bisacodyl, laxodil, laxabene, stadalax), sodium picosulfate. The main indication for the use of bisacodyl is the presence of atonic constipation. Its advantage is the presence of two dosage forms (dragées and suppositories). It can be used in the postoperative period and after childbirth. The advantages of the drug include the rapid (within 1 hour) onset of a laxative effect. The advantage of sodium picosulfate is the ability to select a more precise individual dosage, since it is available in drops. The laxative effect of sodium picosulfate in children is less reliable, since in them the activity of sulfatase-producing bacteria necessary for the action of the drug is significantly lower than in adults. Bisacodyl and sodium picosulfate are most effective for hypotonic constipation and constipation associated with inflammatory pathology of the gastrointestinal tract, as well as in people on bed rest. Disadvantages of intestinal motility stimulants that do not contain anthranoids: cause colic; reduce the absorption of fat-soluble vitamins; Contraindicated for children under 6 years of age, pregnant women, the elderly and patients on bed rest. Summarizing the data on the side effects of laxatives, it should be mentioned that their use is accompanied by increased loss of protein and potassium through the intestines, decreased tone of the intestinal muscles, addiction of the receptor apparatus, requiring increasingly large doses of laxatives, often constipation is replaced by diarrhea due to the resulting drug colitis If you have chronic constipation, you should avoid long-term daily use of laxatives. Different drugs have different ranges of side effects. Very often, the patient is faced with a situation where, against the background of an initial beneficial effect, when the dose is increased, addiction occurs, which subsequently leads to the abuse of laxatives with all the negative consequences. In many cases, it is necessary to carry out painstaking work aimed at weaning patients off the use of laxatives, especially when complaints associated with stool retention are accompanied by complaints characteristic of irritable bowel syndrome (pulling, sometimes cramping abdominal pain, flatulence, etc.). Bisacodyl, senna, buckthorn have a laxative effect, irritating the intestinal mucosa. It is not recommended to take them for a long period of time to treat constipation, as they gradually impair intestinal functions. This leads to increased constipation and the development of colonic atony, in which the intestines lose the ability to move the bolus of food without chemical stimulation. The most serious problem is the occurrence of dependence when taking laxatives, which develops in 13-15% - aloe, 10% - senna preparations, 8-10% - bisacodyl and saline laxatives. Contraindications for prescribing laxatives: intestinal obstruction, acute surgical pathology, severe dehydration, acute and chronic inflammatory diseases of the colon, Crohn's disease. Also, the use of laxatives should be avoided in persons taking broad-spectrum oral antibiotics. Signs of an overdose of laxatives are: diarrhea, symptoms of hypovolemia, symptoms of hypokalemia (decreased reflexes, weakness, rhythm disturbances). Laxatives refer to medications that really sick people or supposedly sick people take in large quantities. They are widely purchased and taken even without a doctor’s prescription, without taking into account contraindications, which can aggravate the course of the disease and cause side effects. Considering the above, it should be noted that laxatives should be used only as prescribed by a doctor, taking into account the etiopathogenetic factors of each patient. Literature Baranskaya E. K. Constipation // Concilium Provisorum.— 2001.— Volume 1, No. 4. Borodina T. V., Bunyatyan N. D. Pharmacological analysis of modern laxatives // Pharmacist.— 1997.— No. 18.— pp. 54–55. Grigorieva P. A., Yakovenko E. P. Constipation: from symptom to diagnosis and adequate treatment // Therapeutic. archive.— 1996.— T. 8.— No. 2.— P. 27–30. Gubergrits N. B. The problem of constipation in therapeutic practice // Health of Ukraine. - 2004. - No. 3. - P. 28. Ducrot F. Constipation: diagnosis and tactics of patient management // Clinical perspectives of gastroenterology, hepatology. - 2002. — No. 9.— P. 35–37. Zlatkina A. R. Problems of choosing laxatives in the treatment of chronic constipation // Farmateka. - 2002. - No. 9. - P. 53–56. Maev I.V. Chronic constipation // Attending physician. - 2001. - No. 7. - P. 53–59. Mumladze R.B., Seltsovsky A.P., Bilyk A.V. et al. Current issues in the prevention and treatment of disorders of intestinal motor-evacuation function in the early postoperative period // Mosk. honey. magazine.— 1998.— No. 1.— P. 18–21. Nikitin I.G., Storozhakov G.I., Fedorov I.G. et al. Duphalac (lactulose) in the treatment of intestinal dysbiosis in non-alcoholic steatohepatitis // Clinical perspectives of gastroenterology, hepatology. - 2002. - No. 1. - P. 24 –29. Sekacheva M.I. Carbohydrate malabsorption syndrome in clinical practice // Clinical perspectives of gastroenterology, hepatology. - 2002. - No. 1. - P. 29–35. Tolochko V. M. Development of the market of herbal medicines for the treatment of diseases of the scolio-intestinal tract // Bulletin of Pharmacy. - 2001. - No. 1. - P. 39–42. Fadeenko G. D. Functional diseases of organs and etching // Suchasna gastroenterology. - 2001. - No. 2. - P. 7–10. Zimmerman Ya. S. Chronic constipation. Diarrhea / Perm: PGMA. - 1999. - 120 p. Brethange JE, Vidon N. Increased all lass in the human jejunum indicated by Laxative/ Gut.— 1981.— No. 22.— P. 246–249. Fusgen I., Schumann C. Clinical aspects and treatment of constipation / Hanover. Curt R. Vincentz Verlag, 2001. 56 p. Hallmann F. Toxicity of commonly used Laxative/ Med Sci monit.— 2000.— No. 6.— P. 618–628.

Mezim

Pancreatin to improve digestion

Mezim is one of those drugs that is widely advertised in the media. One Mezim tablet consists of pancreatin, lipase, amylase and protease. In fact, the composition of Pancreatin tablets is the same. Mezim is prescribed in the following cases:

• Insufficient enzyme production
• For problems associated with food stagnation
• For inflammation of the gastric mucosa
• For chronic pancreatitis

Separately, it is necessary to say about the dosage. You should take one tablet (unless more is prescribed by your doctor) before each meal. Depending on what disease and what problem a person has, the course can last from several days to several months. It is strictly forbidden to take the drug if a person has intestinal obstruction, jaundice or hepatitis.

Mezim can be called a more expensive analogue of Pancreatin. The only thing that distinguishes them from each other is the taste. Most patients note that the coating covering the Mezim tablet is much sweeter and more pleasant than that of Pancreatin. And often, in order to give medicine to children, they buy Mezim.

Intestinal recovery after antibiotic treatment

The intestines suffer greatly from taking antibiotics

A huge number of beneficial microorganisms daily take on the complex processes of assimilation and digestion of food. Moreover, the state of our immunity largely depends on the coordinated work of E. coli colonies in the small intestine.

The breakdown of incoming components of complete nutrition and inhibition of the growth of pathogenic bacteria is the prerogative of lactobacilli. The production of amino acids and vitamins, the breakdown of fats is the responsibility of bifidobacteria.

Taking antibacterial drugs makes the intestinal microflora almost sterile. The consequences of this can be the most unpredictable:

• Irritable bowel syndrome and diarrhea appear.
• Pathogenic strains of bacteria (salmonellosis, dysentery) multiply significantly.
• The level of general immunity decreases.

In order to avoid this, in parallel with the use of antibiotics, it is advisable to take drugs that protect the microflora (Linex, Hilak Forte). If signs of dysbiosis are evident, you need to restore the balance of microflora and follow a special diet. It will help create optimal conditions for the reproduction of the necessary microorganisms.

Foods rich in plant fiber contribute to intestinal restoration. These are fruits and vegetables, with cabbage in first place. In combination with vegetable oil, it will help eliminate pathogenic microorganisms. To populate the intestines with beneficial bacteria, “live” cultures of fermented milk products are needed: kefir, fermented baked milk, yogurt. They can be prepared at home using pharmaceutical preparations Lactobacterin and Bifidumbacterin (2 ampoules per liter) as a starter.

Temporarily you need to give up yeast baked goods, confectionery, tea and coffee. They need to be replaced with juices of fresh fruits and berries, jelly, decoctions of chamomile, sage, and ginger infusion. It is undesirable to use fried, smoked, fatty foods. Instead, it is better to eat porridge, cottage cheese, fresh vegetables and fruits. Several weeks of such a diet, together with the use of drugs prescribed by a doctor to restore microflora, will help the intestines return to health.

Festal

Festal refers to enzyme preparations, which in addition to pancreatin also contain hemicellulose and bovine bile powder. Hemicellulose helps the stomach break down fiber, but ox bile powder improves lipase activity, and as a result promotes normal absorption of fats and vitamins. Thanks to these properties of its constituent components, Festal is able to quickly improve digestion and have an effect on the entire digestive system. It is recommended to use Festal:

1. For problems with the production of enzymes by the pancreas
2. For diarrhea, but only if the main cause is not an intestinal infection
3. For flatulence
4. For irritable bowel syndrome
5. Festal is also recommended to be taken to improve digestion, especially when a large amount of spicy, fatty, salty food has been eaten.

Some experts advise taking a Festal tablet before an ultrasound examination of the abdominal organs.

As for contraindications, it is prohibited to take Festal if:

• A person has acute pancreatitis
• Jaundice of any origin
• Hepatitis
• Intestinal obstruction
• There is individual intolerance to individual components of the drug
• Festal is prescribed with caution to patients who have a disease such as diabetes mellitus because the shell contains glucose and sucrose.

You can buy Festal at any pharmacy kiosk, and its price is quite affordable.

Medicines to help the intestines after poisoning

Drug for restoring intestinal function: Linex

The main drugs for intestinal restoration are probiotics (live cultures of bacteria that replenish colonies of beneficial microorganisms) and prebiotics (substances that supply nutrition to beneficial microbes and work to suppress pathogenic microflora). Probiotics:

• Preparations with monocultures of lactobacilli (Acilact, Biobakton, Lactobacterin).
• Preparations with monocultures of bifidobacteria (Probifor, Bifidumbacterin).
• Preparations with a complex of bifidobacteria and lactobacilli (Florin Forte).
• Preparations with a complex of bifido-lactobacteria and enterococcus (Linex).
• Preparations with bifidobacteria and Escherichia coli (Bifikol).

These products have contraindications: allergies and immune disorders.

Prebiotics: Lactofiltrum, Portalac, Inulin, Duphalac. The advantages of probiotics and prebiotics are combined with drugs such as Bifiform and Hilak Forte. Prebiotics should be prescribed with caution only to those who suffer from diabetes and intestinal obstruction.

When restoring the intestines after poisoning, you should not rush to use pharmaceutical drugs. You need to try to help yourself first by including lactic acid and fermented foods in your diet.

Ensisital

Mezim - an assistant in the digestive process

For those who experience digestive problems, Enzistal will be an excellent drug that can help improve this process. Enzistal contains not only pancreatin, but also hemicellulose, as well as bile components. That is why its effect is much better than simple Pancreatin. Experts recommend taking the drug:

1. If you have problems digesting food caused by a lack of digestive enzymes
2. With increased flatulence
3. If you have problems with chewing function, which most often occurs in people with dentures, or if there is damage to the jaw or gums
4. With a sedentary lifestyle, especially in bedridden patients
5. Enzistal should be taken with caution in patients who:
6. Have liver or kidney failure
7. Jaundice
8. Intestinal obstruction

In most of these cases, the attending physician may prohibit taking the drug altogether, since it can cause serious complications. As for complications after taking it, or rather side effects, the most common occurrences are:

• An allergic reaction that manifests itself as a rash on the skin, tearing
• Painful sensations in the abdominal area
• Nausea
• Diarrhea
• Irritation of the mucous membrane

If at least one of the above side effects occurs, you must immediately stop taking the drug. Enzsital is a drug with a very good effect, and also a fairly low price, which makes it accessible to most consumers.