The pharmacology of peptic ulcer disease

In recent years there has been a dramatic increase in controlled clinical trials evaluating the treatment of peptic ulcer disease. As a result, a number of agents, both old and new, have been demonstrated to be efficacious. This chapter reviews antacids, anticholinergics, cimetidine, bismuth, and carbenoxolone in terms of effectiveness, toxicity, and cost. The impact of these agents, both real and potential, on the natural history of peptic ulcer disease is assessed and a therapeutic approach is suggested. Readers interested in other agents should refer to previous review articles (Bank and Marks, 1973; Christensen, Juhl and Tygstrup, 1977). The goals of peptic ulcer therapy are healing of the ulcer, relief of pain, and prevention of recurrences. In the first 3 sections, the 5 therapeutic agents listed above will be discussed in terms of these objectives. In general, only those trials utilizing upper gastrointestinal radiography or endoscopy as proof of ulcer presence or absence are cited.