Treatment of Peptic Ulcer Disease

For more than a century, peptic ulcer disease has been a major cause of morbidity and mortality. In the early part of the 20th century, when stress and diet were judged to be important pathogenetic factors for peptic ulceration, patients with peptic ulcers were treated with hospitalization, bed rest, and the prescription of “bland” diets. By the 1950s, investigators and clinicians had focused their attention primarily on the pathogenetic role of gastric acid, and antacid therapy had become the treatment of choice for peptic ulcer disease. Antacids given at very high doses healed about 80% of duodenal ulcers after 4 weeks of therapy in comparison with placebo.[1] The histamine H2 receptor antagonist cimetidine became available for clinical use in 1977. H2 receptor antagonists produced good ulcer healing rates, ranging from 80% to 95%, after 6 to 8 weeks of therapy. Acid suppression with antisecretory therapy rapidly emerged as the treatment of choice for patients with peptic ulcer disease. With the advent of proton pump inhibitors (PPIs) in the 1980s, even more potent acid suppression and higher rates of ulcer healing could be achieved. Although most acute peptic ulcerations healed with acid suppression therapy, the majority of patients experienced recurrences within 1 year of discontinuing treatment with antacids or antisecretory agents alone.[2] For most of the 20th century, therefore, peptic ulcer disease was considered a chronic, incurable disorder characterized by frequent exacerbations and remissions.