The pharmacotherapeutic management of duodenal and gastric ulcers

ABSTRACT

Introduction

Although the incidence and prevalence of duodenal and gastric ulcers have been declining, it remains challenging for health care systems. Based on the underlying cause, history, and characteristics of ulcers, management is generally provided by administering proton pump inhibitors (PPIs) or antibiotics.

Areas covered

This article is based on global guidelines and English language literature from the past decade obtained through searches using PubMed, Clinicaltrials.gov, the US FDA, and the Cochrane library. Using a stepwise approach, dose and duration of treatment, drug interactions, warnings and contraindications, adverse effects, and administration points were specified. New drug candidates that may get American and European approvals were also introduced.

Expert opinion

Despite the wide use of PPIs, their development lags behind the clinical need. There is an absolute requirement to develop third-generation PPIs with higher potency and improved pharmacokinetic and safety profiles. Regarding the antibiotic resistance crisis, including those used against H. pylori, conducting more clinical trials and investigating regional antibiotic resistance are warranted. Potassium competitive acid blockers, ilaprazole, and an H. pylori vaccine all show promise for the future.

KEYWORDS:

• Peptic ulcer disease
• helicobacter pylori
• pharmacotherapy
• duodenal ulcer
• gastric ulcer
• clinical management
• proton pump inhibitors
• antibiotic resistance
• personalized medicine
• expert opinion

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Highlights

• The prevalence and incidence of PUD have been declining over the past decade, especially in developed countries. This might be due to the improved hygiene, economic and therapeutic approaches within these regions, which may cause better eradication of H.pylori.

• NSAID-induced PUD and H.pylori infection are the leading cause of PUD in developed countries which is anticipated to follow the same pattern in the following years due to the aging population and increased incidence of cardiovascular and inflammatory diseases, i.e., rheumatoid arthritis.

• Applying a tailored approach is the best choice in managing all types of PUD based on regional resistance, past medical/drug history, H.pylori susceptibility tests, and genetic polymorphisms determining response to PPIs.

• For managing NSAID-induced ulcers, a careful risk assessment should be carried out considering both gastrointestinal and cardiovascular risk factors to see if the patient benefits from concurrent therapy with a gastroprotection agent or not.

• Despite the wide use of PPIs in the management of PUD, their development lags behind the clinical need. There is an absolute requirement to design and develop third-generation PPIs with higher potency and improved pharmacokinetics and safety profile, i.e., rapid and prolonged action, less affected by polymorphisms, and fewer side effects.

• The introduction of potassium-competitive acid blockers, ilaprazole, and possibly an H. pylori vaccine are among the future advances.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.