[Drugs modifying motility in ulcer therapy]

The outstanding success of H2-blocking agents in ulcer therapy proves gastric acid as a dominating factor in the pathogenesis of ulcers. Motility disturbances can be demonstrated in ulcer patients but up to now in therapeutic terms played only a minor role. The therapeutic success of the antimuscarinic drug pirenzepine which inhibits only gastric secretory volume without influencing gastric pH but exerting a significant influence on interdigestive motility of the upper gastrointestinal tract reestablishes this factor to be of pathogenetic relevance. The pathophysiological factor of motility disturbances in the etiology of gastric ulcers is stressed also by the results of a recent therapeutic study comparing ranitidine and cisapride, where the motility-stimulating benzamide showed exactly the same rate of success as the H2-blocker; this holds true for both healing rate and symptomatic improvement. Therefore as far as chronic gastric ulcer is concerned a combination therapy should be preferred thus avoiding the side-effects of a strong and long lasting suppression of gastric acid secretion.