Over the past ten years there have been major advances in the physician's ability to treat patients with
peptic ulcer disease.
Cimetidine continues to be the standard against which newer
therapies are generally compared, although
ranitidine is equally effective for short-term
therapy, more effective for maintenance
therapy, and has a superior safety profile.
Famotidine is an even more potent H2 receptor antagonist, and initial clinical studies are promising. The initial concern for the development of gastric
carcinoid lesions in rodents, maintained for long periods on high doses of
omeprazole, defused the initial enthusiasm for this
hydrogen-potassium ATPase "
proton pump" inhibitor, but recent studies continue to show a marked efficacy of this agent for the short-term care of patients with gastric or
duodenal ulcers and for the management of patients with the
Zollinger-Ellison syndrome. Sulcrate continues to enjoy wide popularity for acute and chronic care of
acid peptic disorders because of its local action and minimal adverse effects.
Pirenzepine is effective in achieving and maintaining healing, but prevalence of
anticholinergic side-effects has hampered enthusiasm for its widespread use. The 2 forerunners in the
prostaglandin analogues arena,
misoprostol and
enprostil, are antisecretory agents when given in sufficiently high doses. These orally administered
prostaglandins have a favourable safety profile, and their only adverse effect is that of the development of transient mild
diarrhea. Finally, while
antacids continue to be used in large amounts because of their over-the-counter availability, their clinical usefulness is limited by their unpalatable taste and the relatively large amounts usually required to achieve
ulcer healing.