Sixty-seven invited participants involved in the development, evaluation, and use of
therapies for
acid-peptic disorders participated in a meeting to discuss the scientific basis for healing actions of
ulcer drugs and the prospects for future developments ("Realities of Mucosal Protection in the Upper Gastrointestinal Tract," Lausanne, Switzerland, November 8-10, 1987). Eighty-one key statements were prepared and subsequently analyzed on the basis of a voting system. Of the 45 statements that dealt with existing
therapies, only 3 statements showed positive consensus (agreement of two-thirds or more of voters) about mechanisms of
ulcer healing. Participants agreed that both (1)
hydrogen/potassium adenosine triphosphatase inhibitors and (2)
histamine H2 antagonists healed
ulcers solely by
acid inhibition, and (3) that
sucralfate works by topical action. Substantial uncertainty about the mechanisms by which
bismuth compounds and
antacids heal
ulcers was noted as well as their wide range of effects. The mechanism of
ulcer healing by
prostaglandins and the clinical relevance of antiulcer effects of drugs demonstrated in acute studies with animals were also controversial. There was greater agreement among participants about unexplored
drug effects that might produce
ulcer healing. Of the 36 such mechanisms surveyed, the most support went to
therapies aimed at enhancement of mucosal blood flow, epithelial restitution, and mucosal alkaline secretion or inhibition of
luminal pepsin activity. The diversity of opinions among participants suggests a high level of empiricism in the development of
ulcer healing drugs apart from those that inhibit
acid secretion. This empiricism probably arises from inadequate understanding of processes of mucosal injury and repair.