Drug therapy of peptic ulcer disease

Most patients with peptic ulcer disease can be treated successfully and safely with an intensive antacid regimen. A high-potency liquid antacid given at a dose of from 15 to 30 mL one and three hours after meals and at bedtime for a period of six to eight weeks is the recommended regimen. For patients who cannot tolerate this regimen, who will not comply with the antacids, or who are not responding, H2 receptor blockers are effective alternative choices. Most patients will respond to a regimen of either cimetidine 300 mg with meals and at bedtime, or ranitidine 150 mg b.i.d. over a six to eight week period. The addition of an anticholinergic agent before bedtime can be useful, particularly for patients who continue to have nocturnal symptoms. In addition, in the absence of contraindications, an anticholinergic agent may be added one-half hour before meals in patients who are not responding fully to an antacid or H2 blocker regimen. The efficacy of combining all three agents has not been well established clinically, although there is evidence that in this fashion gastric acidity can be further reduced. An attractive new alternative as a primary therapy of peptic ulcer disease is sucralfate. Certainly, in patients who are known to be intolerant to antacids and who cannot take cimetidine or ranitidine due to adverse effects, sucralfate should be considered as initial therapy. It should be given one-half hour before meals and at bedtime for a six to eight week period.