Antacids for peptic ulcer: do we have anything better?

During recent years several reports have appeared documenting that antacids containing aluminium hydroxide accelerate the healing process of duodenal ulcer. In gastric ulcer, however, only one study has demonstrated an effect clearly superior to that of placebo. Several studies, in both gastric and duodenal ulcer patients, have not been able to demonstrate any significant difference between antacids and H2 blockers with respect to ulcer healing and symptom relief. An important acknowledgement is the fact that the doses of antacids required for ulcer healing are much smaller than first assumed, and that tablet formulations of antacids are at least as effective as liquid antacid suspensions. The excellent effect of the more convenient low-dose tablet regimens has strengthened the position of antacids in the competition with other anti-ulcer drugs. Usually, side effects of low-dose antacid regimens are few and mild. In patients with impaired renal function, accumulation of absorbed aluminium may have serious consequences. However, in patients with healthy kidneys, aluminium is quickly excreted after absorption, and unhealthy effects are not documented. Antacids should therefore still constitute a cornerstone in the treatment of peptic ulcers.