What are the most commonly used drugs for peptic disease?

Most Commonly Used Drugs for Peptic Disease

Proton Pump Inhibitors (PPIs) are the most commonly used drugs for peptic disease due to their superior efficacy in acid suppression compared to other medication classes. 1

Evidence-Based Comparison of Treatment Options

A. Proton Pump Inhibitors (PPIs)

• PPIs are strongly recommended as first-line empirical acid suppression therapy for patients with peptic disease (strong recommendation, high quality evidence) 2
• They provide superior acid suppression compared to H2RAs, suppressing gastric acid production more effectively 1
• The British Society of Gastroenterology guidelines specifically state that PPIs are an efficacious treatment for functional dyspepsia with well-tolerated safety profile 2
• PPIs are highly effective for healing peptic ulcers, with healing rates of 80-100% within 4 weeks 3
• Common examples include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole

B. H. pylori Eradication Therapy

• Recommended specifically for H. pylori-positive patients with peptic disease 2
• Consists of PPI plus antibiotics (not used as monotherapy) 1
• Eradication of H. pylori decreases peptic ulcer recurrence rates from 50-60% to 0-2% 3
• While highly effective for H. pylori-associated peptic disease, it's not the most commonly used first-line treatment for all peptic disease

C. H2 Receptor Antagonists (H2RAs)

• Less effective than PPIs but more effective than placebo 1
• May be an efficacious treatment for functional dyspepsia but with weaker recommendation (weak recommendation, low quality evidence) 2
• H2RAs decrease the risk of NSAID-associated duodenal ulcers but not gastric ulcers 2
• Examples include ranitidine, famotidine, cimetidine

D. Antacids and Prokinetics

• Prokinetics have variable efficacy depending on drug class 2
• Many prokinetics are unavailable outside Asia and the USA 2
• Antacids are not mentioned as primary therapy in current guidelines
• Prokinetics are recommended with weak evidence for functional dyspepsia 2

Treatment Algorithm for Peptic Disease

1. First-line therapy: PPIs (strong recommendation)

   • Most effective acid suppression
   • Highest healing rates for peptic ulcers
   • Well-tolerated safety profile
   • Use lowest effective dose that controls symptoms 2

2. For H. pylori-positive patients:

   • H. pylori eradication therapy (PPI + antibiotics) 2
   • High-dose PPI increases efficacy of triple therapy (Grade A recommendation) 2

3. Alternative or adjunctive therapy:

   • H2 receptor antagonists if PPIs not tolerated
   • Prokinetics may be considered for specific symptoms (delayed gastric emptying)

4. For NSAID-induced ulcers:

   • PPI therapy plus discontinuation of NSAID when possible 3
   • When NSAID must be continued, PPI co-therapy reduces risk 2

Important Clinical Considerations

• PPI administration timing matters: should be taken 30-60 minutes before meals (except dexlansoprazole) 1
• Regular review of ongoing PPI indications is recommended to avoid inappropriate long-term use 1
• Different PPIs vary in potency, with pantoprazole being less potent than esomeprazole or rabeprazole 1
• For NSAID users at high risk for GI complications, PPIs can reduce the rate of endoscopic NSAID-related ulcers by up to 90% 2

In conclusion, based on the highest quality and most recent evidence, PPIs are the most commonly used drugs for peptic disease due to their superior efficacy, strong recommendations in clinical guidelines, and favorable safety profile compared to other medication classes.