please help me to explain the question on the basis of pharmacology and pathology.
I agree with Dr Hall. There is apparently no therapeutic logic in combining a prokinetic agent such as itopride with an antispasmodic drug like mebeverine in chronic gastritis.
Pharmacological treatment in chronic gastritis generally focusses on:
1. Normalization of gastric motility
2. Normalization of gastric acidity
Prokinetic drugs like itopride help to normalize gastric motility. Mebeverine, however, is an antispasmodic drug indicated in the treatment of Irritable Bowel Syndrome and G.I. spasm. Mebeverine is not indicated for chronic gastritis.
In most cases, addition of a Proton Pump Inhibitor (PPI, e.g. omeprazole, pantoprazole) would help reduce gastric acidity and thereby complement the therapeutic effect of the prokinetic agent. A combination of a prokinetic and a PPI, thus appears therapeutically rational in the management of chronic gastritis.
If chronic gastritis is caused by Helicobacter pylori bacteria. addition of appropriate antimicrobial therapy would also be required.
Hao. I agree with all the above comments and would be interested to know the prescriber's logic! I think gastritis implies an infection, as Dr Hall has alluded to, and that would be the first line of treatment if proven by, for example, the breath test. Gastritis does not necessarily mean gastric stasis which would be the indication for a prokinetic. If there is no stasis what would you expect a prokinetic to achieve? As far as I know mebeverine only works on intestine and not the stomach, rather like octylonium.
Hi again Hao. Thanks for finding out that response.I think that ids a false hope because the stomach produces acid continually, although pepsin stimulated by food does increase it .. but in that case the food itself tends to neutralise it. I can only see a true role for it if the gastritis was causing stasis or bloating.
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