Antacids have served us well for over a century. In terms of
peptic ulcer disease, the attitude in the late 1950s to 1970s that
antacids should be taken only on demand was unjustified and erroneous. 13 recent endoscopic controlled studies have confirmed the efficacy of
antacids in the healing of
duodenal ulcer, achieving about 75% healing in 4 weeks. The efficacy of
antacids in promoting
gastric ulcer healing has been less well studied and the results are controversial. The most appropriate and economical
antacid regimens for the treatment of
duodenal ulcer disease should include
tablets or liquid that have
acid neutralising capacity of 400 mmol/day given at least an hour after meals. As a long term
therapy,
antacids appear to work, but need be taken in multiple daily doses, a regimen which is unlikely to meet with long term patient compliance. Patients with
gastro-oesophageal reflux disorders or pregnancy-related reflux have also benefited from the usage of
antacids ad libitum. Early previous studies have clearly demonstrated the efficacy of
antacids in reducing
gastro-oesophageal reflux and healing of reflux oesophagitis. The acidity of the gastric contents is the major determining factor in the outcome of the aspiration
pneumonitis occurring during delivery. The prophylactic use of
antacids during delivery has helped to reduce the severity of this complication. Similarly, the prophylactic administration of
antacid aiming to maintain gastric pH between 3.5 to 7.0 has resulted in significant reduction of
bleeding due to stress associated
ulcers and/or erosive haemorrhagic
gastritis in
critically ill patients.
Antacid therapy, however, is controversial in the management of nonulcer
dyspepsia or nonsteroidal anti-inflammatory
drug related upper gastrointestinal mucosal damage. Undoubtedly,
antacids have major roles to play in the treatment of gastric acid related disorders. They have clear advantages and disadvantages when compared with the antisecretory agents. New
proton pump inhibitors in particular have certainly superseded
antacids and even the H2-receptor antagonists in many respects. However, the long term safety record of
antacids remains unsurpassed by any of the new antisecretory agents.