The Mechanism of Action of Antacids

The mechanism of action of antacids and the impact of consuming antacids on the stomach, small intestine and crassum CHAPTER 1 INTRODUCTION 1.1 Background Nowadays, many people often experience stomach ulcers. This is caused by several things such as irregular diet, late eating, physical stress, medical conditions and others.IndigestionIt can appear suddenly for a short time (acute), a long time (chronic), or due to special conditions such as other diseases. Most people take ulcer medicine when they feel stomach ulcers. One example of a drug to treat stomach ulcers that is available on the market is Promag, antacids are an element contained in Promag. Our stomach contains, among other things, an acidic substance, namely hydrochloric acid. Antacids are given orally (drink) to reduce the pain caused by an overly acidic stomach, by neutralizing stomach acid. Apart from neutralizing stomach acid, antacids also increase the defense of the gastric mucosa by triggering the production of prostaglandins in the gastric mucosa. Antacids are chemical elements found in ulcer medicine. There are several positive benefits from ulcer medicine (which has been briefly outlined in the paragraph above) if sufferers consume it. In this paper, we want to explore and find out the mechanism of action of antacids and the impact of consuming antacids on the stomach, small intestine and crassum. CHAPTER 2 LITERATURE REVIEW 2.1 Gastric, Intestinal Tenue and Crassum Gasteris an enlargement of the lumen of the digestive tract which is shaped like a pouch. The space in the stomach can be divided into 4 main parts, namely cardia, fundus, corpus/body, and pylorus. The cardia is the part of the stomach that is connected to the esophagus, while the part of the stomach that is connected to the duodenum is the pylorus. Meanwhile, the wall consists of four general layers of the digestive tract, namely mucosa, submucosa, muscularis externa, and serosa. These layers function to protect certain parts of the stomach which are very vulnerable to friction or pressure. In healthy digestion there is a balance between aggressive factors and defensive factors of the stomach. Gastric aggressive factors include acid and pepsin, while gastric defensive factors include mucus secretion, bicarbonate secretion, and blood flow in the stomach. This balance can be described as follows: aggressive factors digest the contents of the gastric lumen and neutralize pathogenic organisms that may enter with food, while defensive factors protect the gastric wall from the damaging effects of the aggressive factors (protecting from autodigestive effects). An imbalance between these two factors can cause certain diseases. For example,The basic pathogenesis of gastritis and peptic ulcers is if there is an imbalance between aggressive factors and defensive factors in the gastroduodenal mucosa, namely an increase in aggressive factors and/or a decrease in the defensive capacity of the mucosa. 2.1.2 Intestinal tenue In the intestine, chemical digestion occurs, namely digestion with the help of enzymes. The small intestine is the longest digestive tract. The length of the small intestine is approximately 8.25 m. The small intestine consists of the duodenum (duodenum), jejunum (empty intestine), and ileum (absorbing intestine). In the duodenum, there is a gallbladder which contains bile, and there is also pancreatic sap which contains various enzymes such as amylase enzyme (converts starch into sugar), trypsinogen enzyme which then becomes trypsin (converts pepsin into amino acids), and lipase enzyme (converts fat into fatty acids and glycerol). Next, the food undergoes chemical digestion by intestinal sap which contains mucus and enzymes produced by the empty intestinal wall (jejunum). In this intestine, food becomes a mashed and runny porridge. Meanwhile, the absorption of food essence is carried out by the surface of the ileum wall which is filled with intestinal protrusions or villi. The presence of these spikes or villi causes the surface area of the ileum to become wider so that absorption occurs well. 2.1.3 Intestinal Crassum IntestinumThe crassum consists of the large intestine (colon) and intestinal axis (rectum). Its main function is to absorb water, form feces and form mucus to lubricate mucosal surfaces. At the junction between the small intestine and the large intestine there is a pouch called the cecum (appendix) and appendix (worm tuft). In humans, it is thought that the worm's tuft functions to fight infection. Inflammation of the worm's tuft is called Appendicitis. In the large intestine live Escherichia coli bacteria which function to decompose food waste and form vitamin K and B complex. In the colon, water levels are also regulated and peristaltic movements push food into the rectum. Feces are formed in the rectum and expelled through the anus. The process of removing feces is called defecation. 2.2 Antacids About 95 million Americans suffer from heartburn caused by stress, eating too much or too fast, or because they eat foods that are too spicy or fatty. Symptoms that appear are burning sensation (hot sensation), passing gas, nausea and pain in the pit of the stomach. Many people treat this condition by using antacids, namely OTC (Over-The-Counter) drugs which are usually taken in liquid or tablet form. Brands commonly used in Indonesia are Mylanta, Promag. One brand in liquid form is Mylanta. The tablets consist of antacid powder combined with flavors and binders. Often the substance simethicone is added to antacids as an active ingredient against gastric gas. 2.2.1 Rules Antacids help neutralize excess stomach acid production. The effectiveness of antacids is differentiated by the reaction stage and their survivability, which are influenced by various factors. Non-metal antacids were also developed because antacids containing metals can inhibit the absorption of many prescription drugs, especially antibiotics. Antacids alone or in combination with simethicone can be used for gastric problems and duodenal edema. If antacids are consumed in large quantities they will cause a laxative effect. Some antacids, such as aluminum carbonate and aluminum hydroxide, may be prescribed with a low-phosphate diet to treat hyperphosphatemia (too much phosphate in the blood). Aluminum carbonate and aluminum hydroxide can be used to prevent the formation of some kidney stones. The work of antacids is neutralization based. For example, when acids react with hydroxide ions, salt and water are formed according to the following equation: HCl (aq) + NaOH (aq) → NaCl (aq) + H2O If sodium bicarbonate (NaHCO3) is used, a reaction will quickly form with stomach acid to increase stomach pH. NaCl, CO2 and H2O are formed as a result of the reaction. One gram of NaHCO3 can neutralize 11.9 mEq of stomach acid. However, very large doses can cause alkaline urine and cause kidney problems. Calcium carbonate and other calcium compounds are used pure or in combination with magnesium. One gram of this type of antacid can neutralize 20mEq of stomach acid. Magnesium compounds consist of magnesium oxide (MgO), magnesium hydroxide (Mg(OH)2) and magnesium carbonate (MgCO3-Mg(OH)2-3H2O). They combine with stomach acid and produce magnesium chloride and water. One gram of magnesium hydroxide can neutralize 32.6 mEq of stomach acid. Magnesium compounds have the advantages of small absorption, long-lasting action and do not produce carbon dioxide, except for magnesium carbonate. However, magnesium chloride produces a laxative effect so the formulations used generally contain calcium carbonate or aluminum hydroxide as well to prevent this effect. Aluminum compounds consist of aluminum hydroxide (Al(OH)3), aluminum carbonate (Al2O3-CO2) and aluminum glycinate, which contains aluminum oxide and glycine acid. Aluminum hydroxide produces aluminum chloride and water. Each milliliter neutralizes 0.4 – 1.8 mEq of stomach acid within 30 minutes. However, if the pH is more than 5, then the neutralization reaction will not take place completely. Aluminum hydroxide has a long shelf life, but causes constipation. Therefore it is necessary to add magnesium antacids. 2.2.2 Types of antacids on the market a. Absorbable antacid This medicine will immediately neutralize all stomach acid. The most powerful are sodium bicarbonate and calcium carbonate, the effects of which are felt immediately after the drug is taken. This drug is absorbed by the bloodstream, so continuous use can cause changes in the acid-base balance of the blood and cause alkalosis (alkaline-milk syndrome). Therefore this drug is usually not used in large amounts for more than a few days. b. Non-absorbable antacid This drug is preferred because it has fewer side effects, does not cause alkalosis. This drug binds with stomach acid to form a substance that remains in the stomach, reducing the activity of digestive fluids and reducing ulcer symptoms without causing alkalosis. But these antacids affect the absorption of other drugs (eg tetracycline, digoxin and iron) into the blood. c. Aluminum Hydroxide It is a relatively safe and widely used antacid. But aluminum can bind to phosphate in the digestive tract, thereby reducing blood phosphate levels and causing loss of appetite and weakness. The risk of developing these side effects is greater in sufferers who are also alcoholics and sufferers of kidney disease (including those undergoing hemodialysis). This drug can also cause constipation. d. Magnesium Hydroxide It is a more effective antacid than aluminum hydroxide. Dosage 4 times 1-2 tablespoons/day usually will not affect bowel habits; but if more than 4 times it can cause diarrhea. A small amount of magnesium is absorbed into the blood, so this drug should be given in small doses to people with kidney damage. Many antacids contain magnesium and aluminum hydroxide. 2.2.3 Indications Antacids are used orally to stop heartburn, which is the main symptom of gastroesophageal reflux disease. Treatment with antacids is symptomatic and can only be used for minor symptoms. The utility of many antacid combinations is unclear, although a combination of magnesium and aluminum salts may prevent irregular defecation behavior.6 2.2.4 Contra-indications There are several contra-indications for antacids contained in ulcer medicine, including: 8,9,10,11 Carbonates: Regular high doses can cause alkalosis, which inhibits the action of other drugs and causes kidney stones. The reaction between carbonate ions and stomach acid can produce carbon dioxide gas, which causes nausea and vomiting that is not well tolerated. Carbon dioxide also causes headaches and reduces muscle flexibility. Aluminum hydroxide: can cause the formation of poorly soluble aluminum phosphate complexes, causing hypophosphatemia and osteomalacia. Although aluminum has low absorption capacity in the gastrointestinal tract, accumulation can occur causing kidney damage and constipation. Magnesium hydroxide: has a laxative effect and can accumulate in the body resulting in kidney failure leading to hypermagnesia and cardiovascular and neurological complications. Sodium : increased sodium consumption can harm arterial hypertension, heart failure and other kidney diseases. A stomach that is less acidic can result in several stomach function disorders, such as defects in the function of digesting and absorbing nutrients (for example: iron and vitamin B complex). Apart from that, antacids can also increase the prevalence of bacterial infections in the stomach and intestines, as well as the bioavailability of some drugs, for example: the bioavailability of ketoconazole (an antifungal) is reduced at high stomach pH. CHAPTER 3 DISCUSSION Antacids are one of the drug choices for treating stomach ulcers. Antacids are given orally (drink) to reduce the pain caused by an overly acidic stomach, by neutralizing stomach acid. Stomach acid is released to help break down proteins. The stomach, intestines, and esophagus are protected from acid by various mechanisms. When the condition of the stomach becomes more acidic or the protective mechanisms are inadequate, the stomach, intestines and esophagus can be damaged because the acid causes various symptoms such as stomach pain, burning sensation and various other gastrointestinal complaints. In general, antacids are weak bases. Usually it consists of an active substance containing aluminum hydroxide, magnesium hydroxide, and calcium (you can see it on the antacid packaging). Sometimes antacids are combined with simethicone which can reduce excess gas. 3.1 Mechanism of action of antacids on the stomach Antacids work by neutralizing excessive stomach acid and protecting the stomach mucous membrane. The following is the mechanism of action of the compounds contained in anticides: Aluminum compound How it works: aluminum compound is a colloidal substance consisting of aluminum hydroxide and aluminum oxide bound to water molecules. Aluminum hydroxide will coat the stomach mucous membrane as a protective layer. Undesirable effects: constipation b. Calcium carbonate How it works: calcium carbonate, a type of lime, was the first antacid used. It works quickly and its stomach acid neutralization capacity is quite high. Undesirable effects: this drug is not recommended for long-term use, because it can cause acid rebound and increase gastrin levels in the serum. Magnesium compounds (magnesium oxide, magnesium carbonate, magnesium trisilicate) How it works: magnesium oxide is more effective at binding acids than calcium carbonate because it is not absorbed so it does not cause alkalosis. Magnesium trisilicate is a non-systemic antacid, acting more slowly and lasting longer than calcium carbonate. This drug in the stomach releases silicium oxide which will coat the stomach mucous membrane with a protective layer. Undesirable effects: diarrhea, to overcome this it is usually combined with aluminum hydroxide which causes constipation. 3.2 Impact of Antacid Consumption on the Gaster and Intestinum As we know, there are still many people who consider antacids or better known as stomach ulcer medicines which are widely sold on the market to treat gastritis, dyspepsia, gastric ulcers, duodenal ulcers, as well as other diseases of the stomach and intestines. Basically, the expected effect of consuming antacids is to suppress gastric acid secretion which is considered excessive, so doctors advise their patients who suffer from gastritis or other disorders related to stomach acid disorders to consume antacids to suppress gastric acid secretion because they believe that gastritis is “hyperacidity of the stomach”. Gastritis is generally characterized by several symptoms such as nausea, dyspepsia (pain in the upper stomach) or heartburn (hot feeling and pain in the pit of the stomach). Heartburn occurs if stomach acid flows back up into the esophagus. whereas the esophagus is actually susceptible to acid because the environment in the esophagus is alkaline. This usually causes people to swallow a lot of saliva when stomach acid collects in the esophagus because alkaline saliva is needed to reduce stomach acid. However, if you eat large amounts of acid, this acid will swell and it will be difficult to push the acid down with saliva, which will result in injury or erosion of the esophagus. This erosion causes pain or what is called heartburn. When heartburn occurs, usually most people will choose to consume antacids which aim to relieve stomach pain, but as we need to know, stomach acid functions to kill bacteria that enter the stomach with food. However, if gastric acid secretion is inhibited by consuming antacids, there are many negative effects on our bodies that we are not aware of, namely as follows: 12 Bacteria containing strong toxins that should not be able to enter the intestines will escape due to the lack of volume of stomach acid used to kill these bacteria. As a result, these bacteria will trigger diarrhea or other diseases. Reduces the secretion of pepsin and hydrochloric acid which are actually used to activate digestive enzymes. This lack of digestive enzymes makes it difficult for the stomach and intestines to break down food and absorb nutrients. These digestive enzymes are released at every stage of digestion starting from saliva to the middle intestine. If secretion is smooth then absorption will also run smoothly. However, on the other hand, if absorption is insufficient, various digestive problems will arise and burden other organs. In this case, in the process of food passing to the crassum intestine, food substances that should have been absorbed by the crassum intestine arrive in the crassum intestine in a state that has not been properly digested. Food that can no longer be absorbed by the body will rot because the temperature in the intestines is warm, which is around 37°C and causes abnormal fermentation which will increase the number of bad bacteria. This large amount of bad bacteria will weaken the human body's immune system. Makes it difficult to absorb iron and minerals such as Ca and Mg. This is why people who have had a gastrectomy (cutting of the stomach) are always accompanied by anemia. The anemia experienced is caused by the absence of gastric acid secretion which actually functions to absorb iron. Disrupting the balance of bacteria in the intestines which will lead to a weakening of the immune system. Gastric acid in humans is secreted by villi which are small protrusions or protrusions of the intestine on the surface of the gastric mucosa. If we get used to taking antacids when we experience heartburn, the villi will become shorter so that their function is weakened. The weakening of the function of these villi can lead to gradual shrinkage of the mucosa which will cause inflammation (atrophic gastritis) and make the intestines a breeding ground for Heliobacter pylori bacteria. This bacteria can worsen atrophic gastritis and in the long term can cause stomach cancer. H.pylori bacteria can hide themselves in mucosal cells or in mucus which protects the mucosa from stomach acid and can be transmitted through the mouth so that the rate of infection with this bacteria increases with age and is estimated at 50 percent in people over 50 years old. However, people who suffer from H.pylori do not always end up developing stomach cancer, but to prevent H.pylori from developing, it is best to avoid consuming antacids as much as possible. In fact, there is not too much gastric acid secretion because stomach acid is produced because it is needed to maintain balance and overall body health. 3.3 Alternative Treatment Methods for Heartburn and Gastritis As we know, the use of antacids, which are still widely used by the public, either due to lack of knowledge or based on the advice of some doctors, has an adverse impact on overall body health, so it is best to avoid consuming antacids as much as possible. Most people consume antacids quite often when they experience heartburn, therefore the simplest way to prevent consuming antacids is to prevent heartburn first. Heartburn, which is the process of stomach acid rising back into the esophagus, can be prevented in the following ways: 12 Don't eat or drink too much Reduce or stop smoking habits Reduce alcohol Cut back on coffee Finish dinner 4-5 hours before bed so that when you sleep your stomach is empty. By preventing heartburn through the methods above, people will avoid consuming antacids because stomach acid does not actually need to be suppressed by antacids. Atrophic gastritis, which people have thought was due to "hyperacidity of the stomach" is actually not the case because, on the contrary, atrophic gastritis occurs due to consumption of antacids in large quantities or with great frequency. As previously explained, the use of antacids will weaken the function of the villi and will lead to mucosal shrinkage. Therefore, when people experience heartburn, the problem is actually food that is difficult to digest when the person consumes food, especially in large quantities. Difficulty digesting food is caused by a lack of digestive enzymes which is also caused by the use of antacids. Therefore, the right step is to consume digestive enzyme supplements which can help the secretion of these enzymes so that they can help digest and break down food that passes through each digestive organ, especially the stomach and intestinal tract. CHAPTER 4 CLOSING 4.1 Conclusion The mechanism of action of the compounds contained in anticides varies from one another. These anticidal compounds also have different side effects. Taking antacids can cause stomach acid secretion to become inhibited, which can result in impaired stomach function. The appropriate treatment for heartburn and gastritis is to take digestive enzyme supplements which can help the secretion of these enzymes so that they can help digest and break down food that passes through each digestive organ, especially the stomach and intestinal tract. 4.2 Suggestions The writing of this paper is still incomplete and has not been explained in detail regarding the topics we discussed. Therefore, we suggest that future authors explore and examine more deeply the other effects of antacids that have not been written in this paper.