Treatment advances in acid secretory disorders: the promise of rapid symptom relief with disease resolution.

Gastric acid-related disorders are common clinical problems associated with a wide range of symptoms. Important advances have occurred over the last 20 yr that have improved our understanding of these disorders as well as our approach to treatment. Today, control of gastric acid secretion represents the cornerstone of effective management of both peptic ulcer disease and gastroesophageal reflux disease (GERD). A variety of acid-reducing strategies are now available to clinicians to manage symptoms and control or resolve disease. Antacids offer rapid symptomatic relief but probably have little effect on overall disease progression. Histamine-2 receptor antagonists can also provide good initial symptomatic treatment in peptic ulcer disease and in mild to moderate GERD. However, problems with postmeal acid control and tachyphylaxis may detract from their long-term usefulness. The availability of proton pump inhibitors (PPIs), which block the final process in H+ ion secretion, has revolutionized our approach to the management of patients with acid secretory disorders. The currently available PPIs, omeprazole and lansoprazole, enable us to control symptoms effectively and safely, hasten healing, and minimize disease recurrence. New PPIs, such as rabeprazole and pantoprazole, will further expand our treatment options and may offer even greater possibilities with regard to rapid symptomatic relief and disease resolution.