Peptic ulcer disease affects 10% of men and 4% of women in the United States at some point in their lives. The two most common
causes are the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacterpylori (H. pylori) bacteria.
The primary treatments for peptic ulcers are medications that suppress the flow of gastric acid, together with antibiotics
to eradicate H. pylori.
The first step is to find out whether H. pylori is present. A number of different tests are used, including the urea breath test, stool antigen test and an endoscopic biopsy.
The standard treatment for this bacteria includes various combinations of two or three antimicrobial drugs.
"When patients with active peptic ulcers are infected with H. pylori, eradication of the infection with antibacterial drugs markedly decreases the incidence of recurrence," says Mark Abramowicz,
MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs. In general, gastroenterologists are aware of the need to test for H. pylori and treat it appropriately, says Michael J. Tocco, RPh, MEd, president of Integrated Pharmacy Solutions Inc. in Stoneham,
Mass.
"General practitioners today are often not as aggressive in seeking and treating H. pylori, especially in the elderly," he says. "The prevalence of this bacteria increases with age, so testing and treating elderly
patients is essential."
A decade ago, Tocco was part of the team at the Institute of Contemporary Pharmacy Research that developed a consensus pharmacotherapy
algorithm on the treatment of H. pylori.
Some Drugs for Peptic Ulcers/GERD
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Patients with peptic ulcers should receive treatment with antisecretory drugs. The available options include proton pump inhibitors
(PPIs) and H2-receptor blockers. Standard doses of PPIs inhibit more than 90% of acid secretion. They are most effective when taken 30
to 60 minutes before the first meal of the day. Once-daily dosing is sufficient, and tolerance does not occur with PPIs.
"PPIs heal peptic ulcers more rapidly than H2-blockers or any other drug. Prilosec (omeprazole) generally is as effective as any other PPI, and is available generically
and over the counter," says Dr. Abramowicz.
H2-blockers are available over the counter and inhibit 50% to 80% of acid secretion. Continuous administration of H2-blockers does lead to pharmacologic tolerance and decreased effectiveness over time.
"Among H2-blockers, the low price of generic cimetidine probably does not outweigh its many adverse drug interactions," says Dr. Abramowicz.
Gastroesophageal reflux disease (GERD), which is the chronic reflux of acid into the esophagus, can lead to esophagitis, esophageal
ulcers, and changes in the lining of the esophagus that increase the risk of developing cancer. Medical therapy for GERD is
based on acid suppression. H2-blockers and antacids are used for patients with mild, intermittent symptoms, while treatment with a PPI is preferred for
those with more severe disease.
