PPIs and H2 -receptor blockers are standard treatment for peptic ulcers and GERD, but lifestyle changes and OTC products can help
Peptic ulcer disease affects 10% of men and 4% of women in the United States at some point in their lives. The two most common causes are the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacterpylori (H. pylori) bacteria.
The primary treatments for peptic ulcers are medications that suppress the flow of gastric acid, together with antibiotics to eradicate H. pylori.
The first step is to find out whether H. pylori is present. A number of different tests are used, including the urea breath test, stool antigen test and an endoscopic biopsy. The standard treatment for this bacteria includes various combinations of two or three antimicrobial drugs.
In general, gastroenterologists are aware of the need to test for H. pylori and treat it appropriately, says Michael J. Tocco, RPh, MEd, president of Integrated Pharmacy Solutions Inc. in Stoneham, Mass.
"General practitioners today are often not as aggressive in seeking and treating H. pylori, especially in the elderly," he says. "The prevalence of this bacteria increases with age, so testing and treating elderly patients is essential."
A decade ago, Tocco was part of the team at the Institute of Contemporary Pharmacy Research that developed a consensus pharmacotherapy algorithm on the treatment of H. pylori.
"PPIs heal peptic ulcers more rapidly than H2-blockers or any other drug. Prilosec (omeprazole) generally is as effective as any other PPI, and is available generically and over the counter," says Dr. Abramowicz.
H2-blockers are available over the counter and inhibit 50% to 80% of acid secretion. Continuous administration of H2-blockers does lead to pharmacologic tolerance and decreased effectiveness over time.
"Among H2-blockers, the low price of generic cimetidine probably does not outweigh its many adverse drug interactions," says Dr. Abramowicz.
Gastroesophageal reflux disease (GERD), which is the chronic reflux of acid into the esophagus, can lead to esophagitis, esophageal ulcers, and changes in the lining of the esophagus that increase the risk of developing cancer. Medical therapy for GERD is based on acid suppression. H2-blockers and antacids are used for patients with mild, intermittent symptoms, while treatment with a PPI is preferred for those with more severe disease.