GI cocktail

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A gastrointestinal cocktail, (also known as a GI cocktail or gastric cocktail), is a mixture of medications used to treat symptoms of dyspepsia. [1] The GI cocktail generally contains a mixture of viscous lidocaine, an antacid, and an anticholinergic. [1] [2] The GI cocktail is commonly prescribed in the hospital or emergency department, and has been used to help distinguish chest pain as either gastrointestinal or cardiac. [1] While it has been widely used in the treatment of dyspepsia, studies have suggested that the GI cocktail is only as effective as antacids alone. [1]

Contents

The "GI cocktail" does not refer to a specific product. Rather, it refers to a mixture of viscous lidocaine, an antacid, and an anticholinergic. [1] [2] Viscous lidocaine works as an anesthetic to numb pain in the throat, esophagus, and stomach. Antacids work to neutralize stomach acid. Anticholinergics work to ease symptoms that accompany dyspepsia including nausea, vomiting, and abdominal cramping.

Contents and dosing

The GI cocktail is a mixture of a viscous anesthetic, an antacid, and an anticholinergic. [1] [2] Common viscous anesthetics use are viscous lidocaine or xylocaine. Common antacids used are magnesium hydroxide, aluminum hydroxide, or simethicone (more commonly known as Mylanta or Maalox). [3] Common anticholinergics used are hyoscyamine sulfate, atropine sulfat e, scopolamine hydrobromide, and phenobarbital (more commonly known as Donnatal). [3] Typical dosing is 5ml of viscous anesthetic, 30ml of liquid antacid, and 10ml of anticholinergic. [3]

Medical uses

The GI cocktail is commonly prescribed in the hospital or emergency department to treat symptoms of dyspepsia. [4] These symptoms include: belching, heartburn, chest pain, abdominal discomfort, abdominal bloating, nausea, loss of appetite, and flatulence. Dyspepsia itself is not an illness, rather it is an indicator of chronic underlying gastrointestinal issues such as peptic ulcer disease, gastro-esophageal reflux disease, h.pylori gastritis, gastroparesis, or upper gastrointestinal cancers. [5] [6] Dyspepsia can additionally be contributed to medications such as potassium supplements, NSAIDs, digitalis, iron, glucocorticoids, and colchicine, as well as lifestyle factors such as diet, stress, and cigarette smoking. [5] [6]

Side effects

Some people experience side effects that are the result of the individual medications used to make the GI cocktail. They include:

Viscous lidocaine: [7]

Antacid: [8]

Anticholinergic: [9]

Efficacy

Prior studies regarding the GI cocktail for management of dyspepsia in the emergency department have varied in quality of methodology and have demonstrated mixed results. A 1990 single-blind study performed by Welling and Watson [4] compared 30 mL of antacid with or without the addition of 15 mL of viscous lidocaine and concluded that the addition of viscous lidocaine provided a significantly greater degree of immediate pain relief than antacids alone in patients with dyspepsia. A 2004 single-blind study performed by Vike and Davis, [7] compared treatment with antacids plus either viscous lidocaine or benzocaine solution and did not find a statistically significant difference between the two treatment arms – however the study lacked an antacid monotherapy arm. A robust double-blind clinical trial performed in 2003 by Berman et al. [1] compared 30 mL of antacid monotherapy, antacid with the addition of 10 ml of an anticholinergic, and an antacid with anticholinergic with the addition of 10 mL of 2% viscous lidocaine. That study demonstrated no statistically significant difference in pain relief between treatment arms and concluded that all treatments were clinically effective. The ultimately recommended antacid monotherapy alone in the treatment of dyspepsia.

Related Research Articles

<span class="mw-page-title-main">Antacid</span> Substance that relieves stomach problems

An antacid is a substance which neutralizes stomach acidity and is used to relieve heartburn, indigestion, or an upset stomach. Some antacids have been used in the treatment of constipation and diarrhea. Marketed antacids contain salts of aluminum, calcium, magnesium, or sodium. Some preparations contain a combination of two salts, such as magnesium carbonate and aluminum hydroxide.

<span class="mw-page-title-main">Local anesthetic</span> Medications to reversibly block pain

A local anesthetic (LA) is a medication that causes absence of all sensation in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensation in the entire body and causes unconsciousness. Local anesthetics are most commonly used to eliminate pain during or after surgery. When it is used on specific nerve pathways, paralysis also can be induced.

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD).

<span class="mw-page-title-main">Lidocaine</span> Local anesthetic

Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidocaine typically begins working within several minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. It is often used mixed with a small amount of adrenaline (epinephrine) to prolong its local effects and to decrease bleeding.

Functional abdominal pain syndrome (FAPS), chronic functional abdominal pain (CFAP), or centrally mediated abdominal pain syndrome (CMAP) is a pain syndrome of the abdomen, that has been present for at least six months, is not well connected to gastrointestinal function, and is accompanied by some loss of everyday activities. The discomfort is persistent, near-constant, or regularly reoccurring. The absence of symptom association with food intake or defecation distinguishes functional abdominal pain syndrome from other functional gastrointestinal illnesses, such as irritable bowel syndrome (IBS) and functional dyspepsia.

<span class="mw-page-title-main">Abdominal pain</span> Stomach aches

Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given that, approaching the examination of a person and planning of a differential diagnosis is extremely important.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

<span class="mw-page-title-main">Gastritis</span> Stomach disease

Gastritis is the inflammation of the lining of the stomach. It may occur as a short episode or may be of a long duration. There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain. Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. Complications may include stomach bleeding, stomach ulcers, and stomach tumors. When due to autoimmune problems, low red blood cells due to not enough vitamin B12 may occur, a condition known as pernicious anemia.

<span class="mw-page-title-main">Simeticone</span> Anti-foaming agent used to reduce bloating, discomfort or pain caused by excessive gas

Simeticone (INN), also known as simethicone (USAN), is an anti-foaming agent used to reduce bloating, discomfort or pain caused by excessive gas.

Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier than expected when eating. Indigestion is relatively common, affecting 20% of people at some point during their life, and is frequently caused by gastroesophageal reflux disease (GERD) or gastritis.

Maalox was a brand of antacid owned by Sanofi. Their main product is a flavored liquid containing a suspension of aluminum hydroxide and magnesium hydroxide, which act to neutralize or reduce stomach acid, for the purpose of relieving the symptoms of indigestion, heartburn, gastroesophageal reflux disease, and also stomach or duodenal ulcers. It also contains simethicone, an anti-foaming agent which helps eliminate bloating from gas. In large doses, the medicine can act as a laxative. The trademark is owned by Novartis International AG, and was first produced commercially in 1949.

Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after a cholecystectomy.

<span class="mw-page-title-main">Mucositis</span> Medical condition

Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. Mucositis can occur anywhere along the gastrointestinal (GI) tract, but oral mucositis refers to the particular inflammation and ulceration that occurs in the mouth. Oral mucositis is a common and often debilitating complication of cancer treatment.

The Rome process and Rome criteria are an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia and rumination syndrome. The Rome diagnostic criteria are set forth by Rome Foundation, a not for profit 501(c)(3) organization based in Raleigh, North Carolina, United States.

Abdominal epilepsy is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity. Though a few cases of it have been reported in adults too. It has been described as a type of temporal lobe epilepsy. Responsiveness to anticonvulsants can aid in the diagnosis. Distinguishing features of abdominal epilepsy include (1) Abnormal laboratory, radiographic, and endoscopic findings revealing paroxysmal GI manifestations of unknown origin (2) CNS symptoms (3) Abnormal EEG. Most published medical literature dealing with abdominal epilepsy is in the form of individual case reports. A 2005 review article found a total of 36 cases described in the medical literature.

In medicine, pink lady is a term used for a combination of medications used to treat gastroesophageal reflux or gastritis. It usually consists of an antacid and the anaesthetic lidocaine. Some variants contain an anticholinergic. The name of the preparation comes from its colour – pink.

<span class="mw-page-title-main">Lubiprostone</span> Medication used for constipation

Lubiprostone, sold under the brand name Amitiza among others, is a medication used in the management of chronic idiopathic constipation, predominantly irritable bowel syndrome-associated constipation in women and opioid-induced constipation. The drug is owned by Mallinckrodt and is marketed by Takeda Pharmaceutical Company.

Donnatal is a combination medication that provides natural belladonna alkaloids in a specific fixed ratio combined with phenobarbital to provide peripheral anticholinergic/antispasmodic action and mild sedation. Donnatal is manufactured for Concordia Pharmaceuticals by IriSys, LLC. It is available as tablets and 5 mL elixir. Active ingredients are listed as: phenobarbital (16.2 mg), hyoscyamine sulfate (0.1037 mg), atropine sulfate (0.0194 mg), and scopolamine hydrobromide (0.0065 mg). The latter two ingredients are found in plants of the family Solanaceae, such as belladonna.

<span class="mw-page-title-main">Itopride</span> Chemical compound

Itopride (INN; brand name Ganaton) is a prokinetic benzamide derivative. These drugs inhibit dopamine and acetylcholine esterase enzyme and have a gastrokinetic effect. Itopride is indicated for the treatment of functional dyspepsia and other gastrointestinal conditions. It is a combined D2 receptor antagonist and acetylcholinesterase inhibitor. Itopride is the dimethoxy analog of trimethobenzamide.

<span class="mw-page-title-main">Nausea</span> Medical symptom or condition

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.

References

  1. 1 2 3 4 5 6 7 Berman DA, Porter RS, Graber M (October 2003). "The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial". The Journal of Emergency Medicine. 25 (3): 239–244. doi:10.1016/S0736-4679(03)00196-3. PMID   14585449.
  2. 1 2 3 Warren J, Cooper B, Jermakoff A, Knott JC (September 2020). "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double-blind Clinical Trial". Academic Emergency Medicine. 27 (9): 905–909. doi:10.1111/acem.14069. hdl: 11343/276044 . PMID   32602148. S2CID   220269999.
  3. 1 2 3 Hamilton R (15 October 2010). Tarascon Pocket Pharmacopoeia 2010 Classic Shirt-Pocket Edition. Jones & Bartlett Learning. ISBN   978-0-7637-7439-4.
  4. 1 2 Welling LR, Watson WA (July 1990). "The emergency department treatment of dyspepsia with antacids and oral lidocaine". Annals of Emergency Medicine. 19 (7): 785–788. doi:10.1016/s0196-0644(05)81704-4. PMID   2202240.
  5. 1 2 Talley NJ, Silverstein MD, Agréus L, Nyrén O, Sonnenberg A, Holtmann G (March 1998). "AGA technical review: evaluation of dyspepsia. American Gastroenterological Association". Gastroenterology. 114 (3): 582–595. doi:10.1016/S0016-5085(98)70542-6. PMID   9496950.
  6. 1 2 Fisher RS, Parkman HP (November 1998). "Management of nonulcer dyspepsia". The New England Journal of Medicine. 339 (19): 1376–1381. doi:10.1056/NEJM199811053391907. PMID   9801400.
  7. 1 2 Vilke GM, Jin A, Davis DP, Chan TC (July 2004). "Prospective randomized study of viscous lidocaine versus benzocaine in a GI cocktail for dyspepsia". The Journal of Emergency Medicine. 27 (1): 7–9. doi:10.1016/j.jemermed.2003.12.026. PMID   15219296.
  8. ↑ "CFR – Code of Federal Regulations Title 21". www.accessdata.fda.gov. Retrieved 22 March 2022.
  9. ↑ Lieberman JA (2004). "Managing anticholinergic side effects". Primary Care Companion to the Journal of Clinical Psychiatry. 6 (Suppl 2): 20–23. PMC   487008 . PMID   16001097.
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