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 have emerged as the treatment of choice for acid-related diseases, including GERD and peptic ulcer disease 2
• Healing rates for peptic ulcers with PPIs are significantly higher (>90% after 4-8 weeks) compared to other treatments 1, 3
• Common PPI options include:
  • Omeprazole 20 mg daily
  • Lansoprazole 30 mg daily
  • Pantoprazole 40 mg daily
  • Rabeprazole 20 mg daily 4
• PPIs should be taken 30-60 minutes before meals to ensure adequate dosing 1

H. pylori Eradication Therapy

• Required specifically 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 1
• Eradication of H. pylori decreases peptic ulcer recurrence rates from approximately 50-60% to 0-2% 5

Second-line and Adjunctive Treatments

H2 Receptor Antagonists (H2RAs)

• Less effective than PPIs but more effective than placebo 1
• Options include ranitidine, famotidine, and nizatidine 1
• H2RAs 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 Based on Patient Presentation

1. For confirmed peptic ulcer disease:

   • Test for H. pylori in all patients 1
   • If H. pylori positive: PPI + appropriate antibiotics (eradication therapy) 1
   • If H. pylori negative: PPI therapy at standard dose for 4-8 weeks 1

2. For patients without alarm symptoms:

   • Begin with a PPI trial (4-8 weeks) 1
   • If partial response: Consider twice-daily PPI dosing 1
   • If persistent symptoms: Consider endoscopy to rule out other conditions 1

3. For NSAID-associated peptic disease:

   • PPIs are significantly more effective than other treatments for healing NSAID-associated gastric ulcers 3
   • Lansoprazole 30 mg daily showed healing rates of 77-79% at 8 weeks compared to 50-55% with active control 3

Clinical Considerations and Pitfalls

• Dosing timing: PPIs should be taken 30-60 minutes before meals to maximize effectiveness 1

• Maintenance therapy: Use the lowest effective PPI dose 1

• Common pitfalls to avoid:

  • Failure to test for H. pylori in patients with peptic ulcer disease
  • Inappropriate long-term PPI use without periodic reassessment
  • Inadequate PPI dosing 1

• Safety considerations: PPIs are remarkably safe with serious adverse events being extremely rare 6

• Drug interactions: Omeprazole and lansoprazole have a greater potential for drug-drug interactions than pantoprazole and rabeprazole 2

• Antioxidant properties: Omeprazole and esomeprazole may provide additional antioxidant benefits compared to other PPIs 7

In conclusion, PPIs represent the most commonly used and effective first-line treatment for peptic disease, with H. pylori eradication therapy being essential for H. pylori-positive cases. H2 blockers, antacids, and prokinetics serve primarily as second-line or adjunctive treatments.