2.5 - Gastrointestinal and antilipidemic agents and spasmolytics

Abstract

During pregnancy, motility changes occur throughout the gastrointestinal tract. These changes are largely attributed to increased levels of progesterone and estrogen. The mechanisms promoting gastroesophageal reflux during gestation primarily involve decreased lower esophageal sphincter (LES) pressure and a decrease in the sphincter's adaptive responses. Gastroesophageal reflux and heartburn are common during pregnancy. In mild cases, lifestyle and dietary modifications alone may be all that is required to improve the symptomatic relief. If drug treatment is indicated, first-line therapy includes antacids or sucralfate. Other drugs include proton-pump inhibitors, bismuth salts, ulcer therapeutics, helicobacterpyloritherapy, atropine and anticholinergic spasmolytics, and prokinetic agents. The chapter then explains the causes of constipation during pregnancy, which can be treated with dietary modification and the use of stool bulking agents, hyperosmotic and saline laxatives, diphenylmethanes, anthraquinone derivatives, consumption of castor oil, emollient laxatives, drugs for inflammatory bowel disease, dimeticon and plant-based carminatives, chenodeoxycholic acid and ursodeoxycholic acid, clofibrine acid derivatives and analogs, cholesterol synthesis-enzyme inhibitors, Cholestyramine and other lipid reducers, and appetite suppressants. The pharmacology and toxicology of these drugs are discussed.