Pharmacotherapy for acid/peptic disorders

In the 1970s, the identification of the histamine H2-receptor by Black and the subsequent development of histamine H2-receptor antagonists revolutionized our understanding and treatment of acid/peptic disorders. More recently, the identification of hydrogen-potassium-stimulated adenosine triphosphatase (H+/K(+)-ATPase) as the proton pump of the parietal cell and the recognition of the prominent role of Helicobacter pylori in the pathogenesis of duodenal and gastric ulceration have heralded a new revolution in our understanding and treatment of these disorders. Substituted benzimidazole compounds (omeprazole, lansoprazole and pantoprazole) that covalently bind to and inactivate the proton pump allow complete and prolonged inhibition of acid secretion. Not only can peptic ulcers now be healed more rapidly with proton pump inhibitors, but refractory ulcers have all but disappeared. Eradication of H. pylori with antibiotics offers, for the first time, a permanent cure for most duodenal and many gastric ulcers.