[Drugs affecting gastric acidity in the therapy of ulcer disease]

The most substantial factor in the pathogenesis of peptic ulcers of the gastroduodenum is a preserved HCl secretion (frequently hypersecretion) and the presence of Helicobacter pylori. In some of the ulcers a part is played by non-steroid antirheumatic drugs. In the treatment inhibition of acid secretion by antagonists of H2 receptors proved useful as they heal approximately 80% ulcers in the course of four weeks. Drugs of this group however, do not resolve the main problem of anti-ulcerous treatment, i.e. the liability of ulcers to relapse. 70-80% of the patients develop a relapse within one to two years. Moreover, in 5-10% of the patients the ulcers are resistant to treatment with H2 receptor antagonists. An obvious advance in treatment are inhibitors of the proton pump which intensely inhibit HCl secretion independently on the type of stimulation. At present in clinical practice omeprazole, lansoprazole and pantoprazole are used, all being derivates of benzimidazole. They are the drugs of choice in ulcers resistant to H2 receptor antagonists, in severe forms of reflux oesophagitis in Zollinger-Ellison's syndrome, in ulcers induced by non-steroid antirheumatics. The most substantial fact is that in combination with amoxacillin (or another suitable antibiotic) in 70-80% of cases they eradicate also Helicobacter pylori and heal in a large percentage (70-80%) the ulcerous defect within two weeks.