Over the last 25 years, a remarkable revolution in the pathophysiology and treatment of gastric and
duodenal ulcers has occurred. Effective
therapies were developed not only to heal
ulcers, but also to cure most patients. The two principal causes for gastric and
duodenal ulcers are either
infection with Helicobacter pylori or the use of non-steroidal anti-inflammatory drugs (
NSAIDs). With H. pylori eradication, gastric and
duodenal ulcers are rapidly becoming historical diseases. This communication reviews the salient pharmacology of the novel
anti-ulcer drugs currently in development, with particular emphasis on the treatment of gastric and
duodenal ulcers. Intense research is currently focused on the development of
proton pump inhibitors primarily for the treatment and prevention of
gastroesophageal reflux disease. The older
proton pump inhibitors,
omeprazole and
lansoprazole, are effective in healing gastric and
duodenal ulcers. Furthermore, both drugs are effective in eradicating H. pylori when given with various
antibiotics.
Pantoprazole,
rabeprazole and
esomeprazole are new
proton pump inhibitors, which appear to have comparable therapeutic profiles with
omeprazole and
lansoprazole.
Rebamipide is a new mucosal
protective drug, which is effective in healing
gastric ulcers.
Polaprezinc and
nocloprost are also mucosal
protective drugs, which are in clinical development. However, none of these three cytoprotective drugs have been evaluated for their efficacy in eradicating H. pylori when given in combination with
antibiotics. Likewise, no published literature exists on the use of these drugs for preventing
NSAID-induced
ulcers. With the rapid eradication of H. pylori currently happening in the developed world, the therapeutic challenge is now directed toward preventing
NSAID-associated
ulcer. Significant reduction of
NSAID-induced
ulcers is achieved by using continuous prophylactic anti-
ulcer therapy (
misoprostol or
omeprazole) or by using
NSAIDs possessing selective COX-2 inhibitory activity. However, outcome clinical studies are needed to compare the adjuvant anti-
ulcer therapies given with COX-1 inhibitors versus the selective
COX-2 inhibitors given alone.