Antacids promote ulcer healing by neutralizing hydrochloric acid and reducing pepsin activity. Antacids don't coat the ulcer. There are two types of antacids: Those that have a systemic effect and antacids without a systemic effect. A systemic effect occurs when the antacid is absorbed.

Sodium bicarbonate is a systemic antacid that has many side effects including sodium excess that causes hypernatremia and water retention. Sodium bicarbonate also causes metabolic alkalosis related to the excess bicarbonate. Therefore, sodium bicarbonate is seldom used to treat peptic ulcers.

Calcium carbonate is most effective in neutralizing acid, however one third to one half of the drug can be systemically absorbed resulting in acid rebound. Hypercalcemia and "milk-alkali syndrome" can result from excessive use of calcium carbonate. Calcium carbonate is intensified if taken with milk products.

Nonsystemic antacids are composed of alkaline salts such as aluminum (aluminum hydroxide, aluminum carbonate) and magnesium (magnesium hydroxide, magnesium carbonate, magnesium trisilicate, and magnesium phosphate). A small degree of systemic absorption occurs with these drugs—mainly with aluminum.

Magnesium hydroxide has greater neutralizing power than aluminum hydroxide, however magnesium compounds can be constipating in long-term use. A combination of magnesium and aluminum salts neutralizes gastric acid without causing constipation or severe diarrhea. Simethicone (an anti-gas agent) is found in many antacids.

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