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

First-Line Treatment Options

Proton Pump Inhibitors (PPIs)

• Standard therapy involves a 4-8 week course at standard dosing 1
• PPIs should be taken 30-60 minutes before meals to ensure adequate effectiveness 1
• Common PPI options include:
  • Omeprazole 20 mg daily
  • Lansoprazole 30 mg daily
  • Pantoprazole 40 mg daily
  • Rabeprazole 20 mg daily

H. pylori Eradication Therapy

• Essential for H. pylori-positive peptic ulcer disease 1
• Eradication therapy (PPI + appropriate antibiotics) cures the underlying disease and prevents recurrence 1
• Common regimens include:
  • Bismuth quadruple therapy
  • Rifabutin triple therapy

Treatment Algorithm

1. Initial Approach: Start with PPI therapy (4-8 weeks) for patients without alarm symptoms 1
2. Testing: Test all patients with confirmed peptic disease for H. pylori 1
3. H. pylori Positive: Provide eradication therapy (PPI + antibiotics) 1
4. H. pylori Negative: Continue PPI therapy at standard dose 1
5. Partial Response: Consider twice-daily PPI dosing 1
6. Maintenance: Use lowest effective PPI dose for maintenance therapy 1

Comparative Efficacy

• PPIs are significantly more effective than H2 receptor antagonists for healing duodenal and gastric ulcers 1, 2
• In clinical studies, lansoprazole 30 mg daily showed healing rates of 77-79% at 8 weeks for NSAID-associated gastric ulcers, compared to 50-55% with active control 3
• PPIs can heal peptic ulcers in approximately 80-100% of patients within 4 weeks 4

Alternative Treatment Options

H2 Receptor Antagonists (H2RAs)

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

Antacids

• Provide direct buffering of gastric acid 1
• Best for on-demand, immediate relief rather than daily maintenance therapy 1
• Limited evidence for effectiveness when used alone for daily acid reduction 1

Prokinetics

• May be considered for dysmotility-like symptoms (fullness, bloating) 1
• Weak recommendation with low-quality evidence 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 or timing (should be taken 30-60 minutes before meals) 1
• Missing non-acid related causes of persistent symptoms 1
• Not considering drug interactions with PPIs 1

Safety Considerations

• PPIs are remarkably safe and effective for persons with peptic ulcer disorders 5
• Potential side effects include headaches, diarrhea, constipation, and nausea (up to 14% of patients) 1
• Long-term PPI use may be associated with vitamin B12 deficiency in elderly patients with prolonged use 1
• Use PPIs at the lowest effective dose for the shortest time needed 1
• Pantoprazole is a preferred PPI option due to its lower potential for drug interactions 1

In conclusion, PPIs are the most commonly used drugs for peptic disease management, followed by H. pylori eradication therapy when indicated, with H2 blockers and antacids/prokinetics serving as alternative or adjunctive treatments.