Medical treatment of peptic ulcers

Since duodenal ulcer can be treated effectively with several drugs (H2 receptor antagonists, sucralfate, colloidal bismuth or antacids) the choice of drug should be determined by cost, ease of administration, and lack of side effects. The H2 receptor antagonists and sucralfate cost about the same and have few side effects. They should both be considered first-line drugs for treatment of duodenal ulcer. Colloidal bismuth is not available for use in the United States, but should be otherwise included in this group. Antacids must be taken more often than H2 receptor antagonists; the liquid antacids are messy, will produce diarrhea in many patients, and have several other side effects that make them a second-choice drug. Although the tricyclic selective anticholinergic pirenzepine has been effective in treating duodenal ulcer, it is not approved in the United States and its role in the treatment of duodenal ulcer is not yet well defined. The only role for pirenzepine presently is as a second drug with the H2 receptor antagonists in the treatment of acid hypersecretion in the Zollinger-Ellison syndrome. The same principles apply in the treatment of gastric ulcers as in duodenal ulcers, with a few exceptions. Gastric ulcers probably respond less to antacids than to H2 receptor antagonists or coating agents such as sucralfate, and preliminary data suggest that long-term maintenance therapy with H2 receptor antagonists to prevent ulcer recurrence is not as effective with gastric ulcers as it is with duodenal ulcers. Several compounds will promote the healing of duodenal and gastric ulcers. These compounds have minimal side effects and are well tolerated by patients. They are without question highly effective acutely, but when discontinued they have no lasting influence on the chronic nature of peptic ulcer disease, and their role in the long-term treatment of peptic ulcer disease is unclear. Thus, whether or not these drugs will actually reduce the need for surgical treatment of peptic ulcer disease remains to be determined.