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

Primary Treatment Options

Proton Pump Inhibitors (PPIs)

• PPIs are the first-line and most commonly used treatment for peptic disease
• Standard therapy involves a 4-8 week course at standard dosing 1
• Examples include omeprazole, lansoprazole, pantoprazole, and rabeprazole
• PPIs have demonstrated superior healing rates compared to other medications:
  • In NSAID-associated gastric ulcers, lansoprazole 30mg daily achieved 79% healing rate at 8 weeks 2
  • PPIs produce healing in >90% of patients with duodenal ulcer after 4 weeks 3
  • PPIs heal >90% of gastric ulcers after 6 weeks 3

H. pylori Eradication Therapy

• Recommended for all H. pylori-positive patients with peptic disease 1
• Cures the underlying disease and prevents recurrence
• Common regimens include:
  • Bismuth quadruple therapy
  • Rifabutin triple therapy
• Eradication of H. pylori decreases peptic ulcer recurrence rates from approximately 50-60% to 0-2% 4

H2 Receptor Antagonists (H2RAs)

• Less effective than PPIs but more effective than placebo 1
• Options include ranitidine, famotidine, and nizatidine
• Reduce the incidence of duodenal ulcers but are less effective for gastric ulcers 1

Antacids and Prokinetics

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

Treatment Algorithm

1. Initial Treatment: Start with a PPI trial (4-8 weeks) for patients without alarm symptoms 1

   • Take PPIs 30-60 minutes before meals for adequate effectiveness
   • Use the lowest effective dose for the shortest time needed

2. Test for H. pylori in all patients with confirmed peptic disease 1

   • If H. pylori positive: Provide eradication therapy (PPI + appropriate antibiotics)
   • If H. pylori negative: Continue PPI therapy at standard dose

3. For partial response: Consider twice-daily PPI dosing 1

4. For maintenance therapy: Use the lowest effective PPI dose 1

5. For refractory cases: Reassess diagnosis with endoscopy and consider alternative medications (H2RAs, prokinetics) 1

Common Pitfalls and Considerations

• 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
• Drug interactions - PPIs may interact with medications metabolized by the CYP450 system (e.g., clopidogrel) 1
  • Pantoprazole is preferred when drug interactions are a concern
• Safety concerns with long-term PPI use:
  • Generally safe class of medications for long-term use 5
  • Potential side effects include headaches, diarrhea, constipation, and nausea (up to 14% of patients) 1
  • Regular review of ongoing indications for PPI use is recommended 1

PPIs remain the cornerstone of peptic disease treatment due to their superior efficacy and favorable safety profile, with H. pylori eradication therapy being essential for those with H. pylori infection.