FORMULARY MANAGEMENT OF ANTIULCER DRUGS - CLINICAL CONSIDERATIONS

Peptic ulcer disease (PUD) is thought to result from an imbalance betw een aggressive (excessive) [especially gastric acid and pepsin] and pr otective (diminished) factors (gastric mucus and bicarbonate, prostagl andins and others) in the stomach. Recent attention has focused on the role of Helicobacter pylori as a cause of chronic active gastritis an d a pathogenic factor in PUD. Antiulcer medications with proven effica cy in the treatment of acute PUD include histamine2 (H-2)-receptor ant agonists, H+/K+-ATPase (proton pump) inhibitors, antacids, sucralfate and prostaglandin analogues. The advent of proton pump inhibitors in p articular has resulted in effective therapy for ulcers that previously would have been considered refractory. H-2-receptor antagonists and s ucralfate are also useful for maintenance therapy of PUD. Recent inter est has focused on strategies aimed at eradicating H. pylori and the e nsuing change in the natural history of PUD, specifically a marked dec rease in ulcer recurrence. In contrast, with standard treatment regime ns there is a high rate of ulcer relapse (50 to 90%) after acute ulcer healing. Eradication of H. pylori has until now required a triple dru g regimen of bismuth and 2 antibiotics, and is too cumbersome for rout ine use. It is likely, however, that treatment aimed at eradicating H. pylori will be routine in the near future and will represent a cost-e ffective alternative to standard long term maintenance therapy.