What are the most commonly used drugs for peptic disease?

Most Common Drugs for Peptic Disease

Proton pump inhibitors (PPIs) are the most commonly used drugs for managing peptic disease due to their superior efficacy in acid suppression and excellent safety profile. 1

Treatment Algorithm for Peptic Disease

1. First-line therapy: Proton Pump Inhibitors (PPIs)

   • Standard therapy involves a 4-8 week course at standard dosing 1
   • Examples include omeprazole 20mg, lansoprazole 30mg, pantoprazole 40mg daily
   • PPIs should be taken 30-60 minutes before meals for optimal efficacy 1
   • PPIs have demonstrated superior healing rates compared to other medications, with healing rates of >90% for duodenal ulcers after 4 weeks 1, 2

2. H. pylori eradication therapy (when applicable)

   • Indicated for all H. pylori-positive patients with peptic disease 1
   • Typically includes a PPI plus appropriate antibiotics
   • Common regimens include bismuth quadruple therapy and rifabutin triple therapy 1
   • Eradication therapy cures the underlying disease and prevents recurrence 1

3. H2 receptor antagonists (H2RAs)

   • Less effective than PPIs but more effective than placebo 1
   • Options include ranitidine, famotidine, and nizatidine
   • May be used as an alternative when PPIs are contraindicated or not tolerated

4. Antacids and prokinetics

   • Antacids provide direct buffering of gastric acid
   • Best for on-demand, immediate relief rather than daily maintenance therapy 1
   • Limited evidence for effectiveness when used alone for daily acid reduction
   • Prokinetic agents may be considered for dysmotility-like symptoms (fullness, bloating) 1

Evidence Supporting PPIs as Most Common Treatment

The American Gastroenterological Association and American College of Gastroenterology both recommend PPIs as the primary treatment for peptic disease 1. In clinical trials, PPIs have consistently demonstrated superior efficacy:

• PPIs administered once daily produced healing in >90% of patients with duodenal ulcer after 4 weeks 3
• In a U.S. multi-center study, lansoprazole 30mg daily was significantly more effective than active control for NSAID-associated gastric ulcer healing (79% vs 55% at 8 weeks) 2
• PPIs have shown improved efficacy over histamine H2 receptor antagonists in acid-related disorders 4

Comparative Effectiveness

• PPIs are more effective than H2RAs for healing erosive esophagitis (92.1% vs 69.9% at 8 weeks) 2
• For NSAID-associated gastric ulcers, lansoprazole demonstrated significantly higher healing rates compared to active control 2
• H. pylori eradication rates with PPI-based triple therapy range from 75-94% 5

Common Pitfalls in Peptic Disease Management

• Failure to test for H. pylori in patients with peptic ulcer disease 1
• Inappropriate long-term PPI use without periodic reassessment 1
• Inadequate PPI dosing - PPIs should be taken 30-60 minutes before meals 1
• Missing non-acid related causes of persistent symptoms 1
• Not considering drug interactions with PPIs, particularly with medications metabolized by the CYP450 system 1

Safety Considerations

• PPIs are remarkably safe for long-term use in peptic ulcer disorders 6
• Serious adverse events are extremely rare 6
• Use the lowest effective PPI dose for the shortest time needed 1
• Pantoprazole is a preferred PPI option due to its lower potential for drug interactions 1
• Regular review of ongoing indications for PPI use is recommended, with de-prescribing considered for patients without definitive indications for chronic PPI use 1

In conclusion, while all four medication classes (PPIs, H. pylori eradication therapy, H2 blockers, and antacids/prokinetics) have roles in peptic disease management, PPIs are clearly the most commonly used drugs for this condition based on current guidelines and evidence.