Some options for treating patients with abdominal pain without concerning features that could be beneficial to know - generally stuff focused at typical gastritis/esophagitis/GERD type symptoms.

• ​​Aluminum and magnesium hydroxide (MAALOX)​​
  • 15mL q6hr PRN or with meals
  • Study suggesting it may have faster onset of action, longer duration, and greater effect on raising esophageal pH compared to calcium carbonate: https://pubmed.ncbi.nlm.nih.gov/11854825/
  • Remember First Aid for Step 1? Side effects are Alu"minimum" = constipation, but Mg = "must go" to the bathroom = diarrhea. So they basically balance out but could cause GI side effects in general.

• Calcium carbonate (TUMS)​
  • 1-4 500mg tablets prn, good for your GERD-y patients.
  • Careful in patients with hypercalcemia, don't give them that milk-alkali syndrome yo!

• Sucralfate (CARAFATE)
  • Helps form protective lining around stomach, good for people with ulcers

• ​​Simethicone (GAS-X)​​​
  • Chewable tablet for abdominal bloating/gas
  • Changes surface tension of gas bubbles, enabling their breakdown and formation of larger bubbles which are more easily eliminated
  • I always add this on with anyone reporting gassiness and they seem to like it

• Famotidine (PEPCID)
  • H2 blocker​
  • Not as effective as PPI
  • Has some tachyphylaxis - effects wear off over a few weeks
  • Good if you want to do something sort of in between doing nothing vs starting a PPI

• Pantoprazole (PROTONIX)
  • Official indications for PPI for "stress ulcer prophylaxis" in the hospital: https://litfl.com/stress-ulcer-prophylaxis/​
    • Mechanical ventilation > 48 hours​
    • INR > 1.5, platelets < 50, PTT > 2 ULN in ICU patients
    • Relative indications - past history of gastric ulcer or GI bleeding in past 12 months, trauma (TBI, spinal cord injury, or burns), or 2+ of the following: > 1 week in ICU, occult GI bleeding, steroids > 250mg hydrocortisone/week)
  • Side effects of long-term PPI use = malabsorption and infection​
  • Increased risk of C. diff and pneumonia in ventilated ICU patients
• GI cocktail (order set available at UC Davis, commonly used in ED)
  • The GI cocktail is no more effective than plain liquid antacid - RCT study
  • So, seems like the viscous lidocaine and anticholinergic don't really do anything . . . but I find it's worth trying the viscous lidocaine if the patient is really complaining. Sometimes if it's some irritation of mucosal lining in the esophagus for example, I could see how it would be helpful. Here's an old 1990 study which said the combo was better (but as above, the more recent study argues against this being helpful)​
  • MAALOX (aluminum and magnesium hydroxide) - 30 mL​
  • Viscous lidocaine 2% - 10 mL
  • Phenobarbital + belladona alkaloids aka DONNATAL (anticholinergic) - 5 mL

• Make sure they aren't on meds that can cause abdominal pain​
  • No NSAIDs​
  • Less bowel regimen (stimulants like bisacodyl and senna or osmotics like lactulose which can cause bloating)