Appropriate acid suppression in the treatment of acid-related conditions

Gastric acid is involved in the pathogenesis of duodenal ulcer, gastric ulcer and gastro-oesophageal reflux disease. Although levels of acid secretion may not be abnormally high in patients with these conditions, pharmacological suppression of acid secretion is associated with healing of mucosal defects and maintenance of healing in the long term. In the case of duodenal ulcer, this was demonstrated before the understanding of the importance of Helicobacter pylori infection. There is a considerable body of published work examining the pharmacological effectiveness of antisecretory drugs in suppressing gastric acid secretion, as well as their therapeutic efficacy in terms of healing ulcers or oesophageal erosions. These two parameters have been significantly correlated in each of the three conditions listed above. The purpose of this article is to review the mathematical relationships established between suppression of gastric acid secretion and healing rates of duodenal ulcer, gastric ulcer and gastro-oesophageal reflux disease.