Drug Effects on the Gastrointestinal System: A Physician Perspective

Gastrointestinal manifestations resulting from either prescribed medications or over the counter drugs are commonly encountered in clinical practice. Adverse drug events (ADEs) are often mistaken for a disease process or a syndrome, leading to multiple and unnecessary diagnostic studies, hospitalizations, and poor outcomes. The morbidity, mortality, and health care costs associated with adverse drug events, even restricted to the GI tract, are underestimated. The consequences of adverse effects may be asymptomatic or range from mild abdominal discomfort to fatal hemorrhage, perforation, and requirement for hospitalization, including surgery. Increased awareness and recognition of the intended and unacceptable effects of medications on the gastrointestinal tract and taking steps to withdraw the offending medication or revising the regimen will help improve outcomes. The Beers criteria, which are updated annually, provide a concise list of medications to avoid or use with caution in older adults. Polypharmacy is common in older adults and leads to adverse drug events due to drug-drug or drug-disease interactions. Appropriate deprescribing, referring to the timely discontinuation or decrease in dosage of offending drugs, may be the answer to polypharmacy in order to minimize adverse drug-related outcomes.