Until 1950 the clinical treatment of
peptic ulcer disease relied on dieting and
antacids. However, recent controlled studies suggest that the natural course of
peptic ulcer disease is not affected by diet.
Antacids are primarily used to relieve distress, although high- and low-dose
antacid regimens have been reported to promote
duodenal ulcer healing. Initial favorable reports following the introduction of synthetic
anticholinergic drugs have not been confirmed.
Pirenzepine is an
anticholinergic compound with a specific action on the
muscarinic receptors of the parietal cells. Although
pirenzepine appears effective in
peptic ulcer, the results obtained in different centers have not been uniform.
Sucralfate and
tripotassium dicitrato bismuthate both act locally by coating the
ulcer crater, the latter agent also liberating
prostaglandins. Most prospective studies suggest that both drugs are effective when compared with placebo.
Carbenoxolone heals 70% of
gastric ulcers but is less effective against
duodenal ulcers, and has a high incidence of side-effects. Treatment of
peptic ulcer in the 1980s has been dominated by the advent of the H2-blockers,
cimetidine and
ranitidine.
Peptic ulcer healing rates are similar with both drugs, and the main problem is how often and how much should be given in order to provide acceptable healing and to prevent
ulcer recurrence. Other H2-blockers are being tested and they may be more effective either by healing more
ulcers or healing them earlier. The clinical treatment of
peptic ulcers will in future be advanced by the addition of two new classes of drugs, the
prostaglandins and the
benzimidazole derivatives, which are currently being investigated and appear extremely promising.