Antacids have for long been regarded as the mainstay of pharmacologic
therapy in patients with
dyspepsia. The advent of the
histamine H2-antagonist and of
proton pump inhibitors has provided simpler and overall more efficient therapeutic modalities for severe forms of
dyspepsia. This relates especially to aggressive forms of
peptic ulcer disease and severe reflux oesophagitis, where even high dose
histamine H2-antagonist
therapy has its clear limitations.
Antacids nevertheless continue to be widely used in less severe forms of
dyspepsia, especially in patients suffering from
heartburn. In such patients
self medication of
antacids as first therapeutic measure is still very common. This is well exemplified by an American nd British survey. Out of 6760 randomly selected British general practice patients 875 suffered from reflux-like symptomatology without having consulted their physician for the symptomatology for minimum one year.
Antacids were taken by 61% of them. The advent of controlled endoscopic trials and the emergence of the H2-receptor blockers as a yardstick of
ulcer therapy, however, facilitated reappraisal of the value of
antacids in various conditions. This has given a clear-cut answer in well defined entities such as
peptic ulcer disease and stress
ulcer prophylaxis but has left many open questions in heterogeneous conditions especially in and around
gastroesophageal reflux disease.