Treatment of acid-related disorders with gastric acid inhibitors: the state of the art.
Since their introduction in 1976, and until recently, the H2-receptor antagonists have been the 'state-of-the-art' gastric acid inhibitors, but the advent of omeprazole, the acid pump inhibitor, has necessitated a reassessment of therapy for acid-related diseases. In making this reassessment, the following therapeutic goals should be considered: rapid and reliable therapeutic effect, safety, simple treatment regimen, resolution of recurrence, and cost-effectiveness. Extensive clinical evidence indicates that omeprazole offers an advance over the H2-receptor antagonists in achieving these goals. A series of meta-analyses shows that omeprazole gives more rapid symptom relief and more reliable healing than H2-receptor antagonist, ranitidine, in uncomplicated duodenal ulcer (DU), in uncomplicated gastric ulcer (GU) and in reflux oesophagitis (RO). By contrast with the H2-receptor antagonists, refractoriness leading to failure to heal is virtually unknown with omeprazole. Omeprazole also fulfils the goal of therapeutic safety, and this has been documented in extensive short- and long-term clinical and laboratory studies. Omeprazole has a simple treatment regimen: 20 mg once daily is recommended in the routine treatment of DU, GU and RO. As a result of its high therapeutic success rate, omeprazole is also cost-effective. Taking all these factors into account, it is concluded that omeprazole approaches the therapeutic targets set for the treatment of acid-related disorders.
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Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
D005744:Gastric Acid / Q000378:metabolism; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015201:Meta-Analysis as Topic; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000503:physiopathology; D012008:Recurrence
D006635:Histamine H2 Antagonists; D009853:Omeprazole