Antiulcer drugs are a class of drugs, exclusive of the antibacterial agents, used to treat ulcers in the stomach and the upper part of the small intestine.
Recurrent gastric and duodenal ulcers are caused by Helicobacter pyloriinfections, and are treated with combination treatments that incorporate antibiotic therapy with gastric acid suppression. Additionally, bismuth compounds have been used. The primary class of drugs used for gastric acid suppression are the proton pump inhibitors, omeprazole, lansoprazole, pantoprazole and rabeprazole. The H-2 receptor blocking agents, cimetidine, famotidine, nizatidine, and ranitidine have been used for this purpose, but are now more widely used for maintenance therapy after treatment with the proton pump inhibitors. Sucralfate, which acts by forming a protective coating over the ulcerate lesion, is also used in ulcer treatment and may be appropriate for patients in whom other classes of drugs are not indicated, or those whose gastric ulcers are caused by non-steroidal anti-inflammatory drugs (NSAIDs) rather than H. pylori infections.
The proton pump inhibitors block the secretion of gastric acid by the gastric parietal cells. The extent of inhibition
of acid secretion is dose related. In some cases, gastric acid secretion is completely blocked for over 24 hours on a single dose. In addition to their role in treatment of gastric ulcers, the proton pump inhibitors are used to treat syndromes of excessive acid secretion (Zollinger-Ellison Syndrome) and gastroesophageal reflux disease (GERD).
Histamine H-2 receptor blockers stop the action of histamine on the gastric parietal cells, inhibiting the secretion of gastric acid. These drugs are less effective than the proton pump inhibitors, but may achieve a 75–79% reduction in acid secretion. Higher rates of acid inhibition may be achieved when the drug is administered by the intravenous route. The H-2 receptor blockers may also be used to treat heartburn and hypersecretory syndromes. When given before surgery, the H-2 receptor blockers are useful in prevention of aspiration pneumonia.
Sucralfate (Carafate), a substituted sugar molecule with no nutritional value, does not inhibit gastric acid, but rather, reacts with existing stomach acid to form a thick coating that covers the surface of an ulcer, protecting the open area from further damage. A secondary effect is to act as an inhibitor of the digestive enzyme pepsin. Sucralfate does not bind to the normal stomach lining. The drug has been used for prevention of stress ulcers, the type seen in patients exposed to physical stress such as burns and surgery. It has no systemic effects.
Samuel Uretsky PharmD, The Gale Group Inc., Gale, Detroit,