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Gastrointestinal damage in rheumatoid arthritis, connective tissue diseases, Bechterew and Crohn.Questions asked to Dr M. De Man, internist and gastroenterologist O.L. Vrouw-Clinic Aalst, in reference to his lecture on 21 February 1998 for the department of West-Vlaanderen.
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| What connection is there between oesophageal problems and Bechterews disease, or between oesophageal problems and rheumatoid arthritis? | |
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There is no typical association between Bechterews disease and oesophageal damage. Only rarely is there an association with Crohns disease (ulcers at the level of the gastrointestinal mucous membrane which can infiltrate deeply through the intestinal wall). An association between oesophageal damage and rheumatoid arthritis is rare and is based on the same abnormalities seen in systemic sclerosis. One has to bear in mind that a reflux occurs frequently, without an underlying disease and it also often occurs in systemic diseases.
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| What is the difference between the various existing drugs? | |
| Drugs that reduce gastric juice are divided into two categories: 1. H2-antagonists: Cimetidine, Ranitidine, Nizatidine and Famotidine. These medications block the H2 receptors in the gastric mucosa and are very efficient to treat gastric and duodenal ulcers. They are also indicated to treat mild oesophagitis, but are insufficient to treat serious oesophageal ulcers. These drugs rarely have side effects.
2. Proton pumpinhibitors: Omeprazol, Lanzoprazol and Pantoprazol. |
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| Is it dangerous to take antacids such as Maalox, Mylanta on a long-term basis? | |
| Antacids only have a short span of effectiveness by neutralising the gastric acid. They should not be taken together with other drugs as they can interfere with their absorption. Taking high doses for a long time may cause side effects due to the absorption of sodium, calcium, magnesium or aluminium salts present in these antacids preparations. Some preparations cause constipation while others cause diarrhoea. Long-term usage in high doses is not recommendable: they should be taken for pain relief in case of oesophageal, gastric and duodenal ulcers for which another treatment has been set up.
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| Do gastric juice inhibitors influence the digestion process? | |
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Gastric juice plays a role in the digestion process. In the treatment of gastric or oesophageal ulcers, however, there is no complete inhibition of acid and it is not necessary to eliminate the acid completely to heal the ulcers. As such, treatment with these drugs has no noticeable effect on the digestion process.
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| Is there something you can do if there is an obstruction of food in the oesophagus? | |
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Try gently to drink some water and if this does not cause the food to slide through, there is in fact no other solution than to call for an endoscopy. By means of an endoscopy a possible constriction can be detected. Food impaction (obstruction of food in the oesophagus) may be caused by a constriction in the oesophagus due to an underlying disease or a motor impairment (disorder of the oesophageal movement).
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| Can prostaglandins (important inflammation regulators) be taken in tablets, or do they have to be injected? | |
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Prostaglandins in tablets are the most effective at the level of the gastrointestinal tract. If the medication is needed elsewhere, it is not possible to simply replace the intravenous injections by tablets. Prostaglandins in tablets are used to treat gastric ulcers and to prevent the formation of ulcers in case nonsteroidal anti-inflammatory drugs are taken.
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| Do painkillers influence the stool? | |
| Do painkillers influence the stool?
Nonsteroidal painkillers have no or little effect on the stool. They could, however, provoke ulcers on the large intestine and very often on the small intestine. This does not provoke hard stool, but rather diarrhoea.
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| Could nonsteroidal anti-inflammatory drugs (corticosteroid is a steroid) be the cause of abnormalities or ulcers in the oesophagus? | |
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Nonsteroidal anti-inflammatory drugs do not cause abnormalities, but they can stimulate them.
If, for example, a tablet remains stuck in the oesophagus due to oesophageal motor impairments, an ulcer could be burned in it; this occurs only rarely though. Nevertheless, nonsteroidal anti-inflammatory drugs may worsen previous lesions. By restraining the production of prostaglandins, they reduce the recuperative power of the mucous membrane. These drugs may also decrease the blood coagulation, so that bleedings may occur.
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| Is the effect of gastric acid inhibitors and nonsteroidal drugs reduced when taken at the same time? | |
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No, drugs to treat gastric problems do not influence in any way the effect of nonsteroidal medications.
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| Do bowel perforations often occur in systemic diseases? | |
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Fortunately, this occurs only rarely. Lesions due to vasculitis that occur in systemic diseases may cause ulcers at the level of the gastrointestinal tract, which rarely lead to perforations. The intake of corticosteroids also increases the risk of perforating lesions in the stomach or in the large intestine. Special attention should be drawn to it because the symptoms may be disguised by the intake of corticosteroids.
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| What is a gastric hernia and is there a connection with a reflux? |
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The presence of a gastric hernia stimulates the gastroesophageal reflux. The passage from the oesophagus to the stomach is situated at the level of the diaphragm. The oesophagus is situated in the chest cavity, the stomach in the abdominal cavity. The diaphragm helps the sphincter muscle to close the entrance between the oesophagus and the stomach more powerfully, if the pressure from the abdomen increases during activities such as coughing, laughing, and bending.
In case of a gastric fracture (hernia), part of the stomach moves to the chest cavity and the diaphragm is no longer a barrier between the oesophagus and the stomach. Patients with a gastric fracture are treated with the same drugs as patients with a reflux without a hernia.
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