Since
duodenal ulcer can be treated effectively with several drugs (H2 receptor antagonists,
sucralfate, colloidal
bismuth or
antacids) the choice of
drug should be determined by cost, ease of administration, and lack of side effects. The H2 receptor antagonists and
sucralfate cost about the same and have few side effects. They should both be considered first-line drugs for treatment of
duodenal ulcer. Colloidal
bismuth is not available for use in the United States, but should be otherwise included in this group.
Antacids must be taken more often than H2 receptor antagonists; the liquid
antacids are messy, will produce
diarrhea in many patients, and have several other side effects that make them a second-choice
drug. Although the tricyclic selective
anticholinergic pirenzepine has been effective in treating
duodenal ulcer, it is not approved in the United States and its role in the treatment of
duodenal ulcer is not yet well defined. The only role for
pirenzepine presently is as a second
drug with the H2 receptor antagonists in the treatment of
acid hypersecretion in the
Zollinger-Ellison syndrome. The same principles apply in the treatment of
gastric ulcers as in
duodenal ulcers, with a few exceptions.
Gastric ulcers probably respond less to
antacids than to H2 receptor antagonists or coating agents such as
sucralfate, and preliminary data suggest that long-term maintenance
therapy with H2 receptor antagonists to prevent
ulcer recurrence is not as effective with
gastric ulcers as it is with
duodenal ulcers. Several compounds will promote the healing of duodenal and
gastric ulcers. These compounds have minimal side effects and are well tolerated by patients. They are without question highly effective acutely, but when discontinued they have no lasting influence on the chronic nature of
peptic ulcer disease, and their role in the long-term treatment of
peptic ulcer disease is unclear. Thus, whether or not these drugs will actually reduce the need for surgical treatment of
peptic ulcer disease remains to be determined.