Pharmacological management of patients with peptic ulcer disease: prospects for the late 1980's.

Over the past ten years there have been major advances in the physician's ability to treat patients with peptic ulcer disease. Cimetidine continues to be the standard against which newer therapies are generally compared, although ranitidine is equally effective for short-term therapy, more effective for maintenance therapy, and has a superior safety profile. Famotidine is an even more potent H2 receptor antagonist, and initial clinical studies are promising. The initial concern for the development of gastric carcinoid lesions in rodents, maintained for long periods on high doses of omeprazole, defused the initial enthusiasm for this hydrogen-potassium ATPase "proton pump" inhibitor, but recent studies continue to show a marked efficacy of this agent for the short-term care of patients with gastric or duodenal ulcers and for the management of patients with the Zollinger-Ellison syndrome. Sulcrate continues to enjoy wide popularity for acute and chronic care of acid peptic disorders because of its local action and minimal adverse effects. Pirenzepine is effective in achieving and maintaining healing, but prevalence of anticholinergic side-effects has hampered enthusiasm for its widespread use. The 2 forerunners in the prostaglandin analogues arena, misoprostol and enprostil, are antisecretory agents when given in sufficiently high doses. These orally administered prostaglandins have a favourable safety profile, and their only adverse effect is that of the development of transient mild diarrhea. Finally, while antacids continue to be used in large amounts because of their over-the-counter availability, their clinical usefulness is limited by their unpalatable taste and the relatively large amounts usually required to achieve ulcer healing.