What are the most common drugs used in the management of peptic disease?

Most Common Drugs Used in Peptic Disease Management

H. pylori eradication therapy is the most common and effective treatment for peptic disease, as it addresses the underlying cause and significantly reduces recurrence rates from 50-60% to 0-2%. 1

Prevalence and Causes of Peptic Disease

Peptic ulcer disease affects approximately 1% of the US population, with around 54,000 hospital admissions annually for bleeding peptic ulcers 1. The two primary causes are:

• Helicobacter pylori infection (42% of cases)
• NSAID/aspirin use (36% of cases)

First-Line Treatment Options

1. H. pylori Eradication (Option B)

H. pylori eradication is the cornerstone of peptic ulcer treatment when the infection is present. This approach:

• Addresses the root cause rather than just symptoms
• Prevents recurrence in 98-100% of cases (compared to 40-50% recurrence with acid suppression alone) 1
• Typically consists of a PPI plus two antibiotics (triple therapy)

The American Gastroenterological Association recommends using potassium-competitive acid blockers (P-CABs) in place of PPIs in eradication regimens for most patients with H. pylori infection due to higher eradication rates (92% vs 80%) 2.

2. Proton Pump Inhibitors (Option A)

Long-term PPI therapy is commonly used for:

• Acid-related conditions including GERD and peptic ulcer disease 2
• Healing of peptic ulcers (80-100% healing within 4 weeks) 1
• Maintenance therapy for erosive esophagitis 3

PPIs are more effective than H2 blockers for healing duodenal and gastric ulcers 4. Standard dosing includes:

• Omeprazole 20mg daily
• Lansoprazole 30mg daily
• Pantoprazole 40mg daily
• Rabeprazole 20mg daily

For NSAID-associated gastric ulcers, lansoprazole 30mg daily has shown significantly higher healing rates (79%) compared to active control (55%) at 8 weeks 5.

3. H2 Receptor Antagonists (Option C)

H2 blockers are less commonly used as primary therapy because:

• They are significantly less effective than PPIs for severe esophagitis 3
• PPIs have improved efficacy over H2 receptor antagonists in acid-related disorders 4

However, they may be used:

• For breakthrough symptoms in PPI responders 3
• When PPIs are contraindicated
• In combination with antimotility drugs for short bowel syndrome 2

4. Antacids (Option D)

Antacids are the least commonly used as primary therapy for peptic disease because:

• They provide only temporary symptomatic relief
• They don't address underlying causes
• They require frequent dosing
• They're less effective than other options for healing

Treatment Algorithm

1. For H. pylori positive peptic ulcer:

   • First-line: H. pylori eradication therapy (PPI or P-CAB + antibiotics)
   • Follow-up: Confirm eradication and assess symptom resolution

2. For NSAID-associated peptic ulcer:

   • First-line: Discontinue NSAID if possible + PPI therapy
   • Alternative: Continue NSAID + PPI for prophylaxis if NSAID cannot be discontinued

3. For acid-related peptic disease without H. pylori or NSAID use:

   • First-line: PPI therapy (4-8 weeks for healing)
   • Maintenance: Lowest effective PPI dose or on-demand therapy

Conclusion

While all four options (long-term PPI, H. pylori eradication, H2 blockers, and antacids) are used in peptic disease management, H. pylori eradication therapy is the most effective approach when the infection is present, as it addresses the underlying cause rather than just managing symptoms. For non-H. pylori related peptic disease, PPIs remain the most commonly used and effective medication class.