First-Choice Treatment in Uncomplicated Ulcer Disease: A Case for Acid Inhibitors

Abstract

First-choice treatment in uncomplicated ulcer disease is determined by the main therapeutic aims, namely pain relief, prompt healing, simple administration form, and safety. Today these goals can be best achieved with H₂-receptor antagonists, which, among the antisecretory substances currently available, show a prominent and well-defined clinical efficacy and safety profile. The major disadvantage of antimuscarinics such as pirenzepine and prostaglandin analogs such as misoprostol is their narrow therapeutic range; the effective antiulcer dose is very close to the dose that produces relevant side effects. Omeprazole, although providing the best clinical results in acid-related diseases carries at least theoretically some potential risks, such as ECL-cell hyperplasia. With H₂-receptor antagonists, today the question continually arises as to how the therapeutic results could be improved through a substantial reduction of both day- and night-time acidity. A single early evening administration versus bedtime application of H₂-receptor antagonists does not accelerate healing and pain relief in peptic ulcer disease.

Key Words:

• Antisecretory drugs
• H₂-receptor antagonists
• optimal reduction of acidity
• uncomplicated ulcer disease