EMERGING STRATEGIES FOR MANAGING PEPTIC-ULCER DISEASE

The relationship between the inhibition of intragastric acidity and he aling has been determined for both duodenal and gastric ulcers, with a stronger correlation being evident in duodenal ulcer. Omeprazole is c learly more effective than H-2-receptor antagonists in healing duodena l ulcers and in the resolution of attendant symptoms. As the recommend ed treatment periods are shorter with omeprazole (e.g. 2-4 weeks) than with H-2-receptor antagonists (4-8 weeks), omeprazole has also been s hown to be more cost-effective. Long-term management strategies for pe ptic ulcer are evolving rapidly in the light of evidence that Helicoba cter pylori eradication reduces or eliminates ulcer relapse. Regimens, such as omeprazole in combination with amoxycillin or clarithromycin, that both eradicate H pylori and heal ulcers rapidly are appealing be cause they are simple, well tolerated, convenient and efficient in bot h healing ulcers and preventing relapse. This comprehensive approach a ppears to be evolving as the dominant strategy for the future treatmen t of peptic ulcer diseases. Gastric ulcer disease is also treated more effectively with omeprazole than with Hz-receptor antagonists, both i n terms of speed and reliability of healing, and in terms of symptom r esolution. At 4 weeks, symptom resolution has been specifically examin ed in six comparative trials; in three of these, omeprazole was superi or to the H-2-receptor antagonist, and in the other three was at least as good as the H-2-receptor antagonist. Omeprazole, 40 mg once daily, effectively heals non-steroidal anti-inflammatory drug (NSAID)-induce d ulcers in about 90% of cases, even if NSAID therapy is continued, an d is probably the treatment of choice for patients with ulcers requiri ng continued NSAID therapy. It has yet to be determined whether inhibi tion of gastric acid secretion will prevent the formation of NSAID-ind uced gastric ulcers.