Progress with proton pump inhibitors in acid peptic disease: treatment of duodenal and gastric ulcer.

To date, the primary therapeutic approach to peptic ulcer disease, either gastric or duodenal ulcer, remains the inhibition of gastric acid secretion. The major therapeutic goals in peptic ulcer disease are symptom relief, acceleration of crater healing, and the prevention of relapse or recurrence. Since the introduction of H2-receptor antagonists and proton pump inhibitors, the full control of acid secretion can be achieved. In the treatment of gastric ulcer, analysis of all studies that have compared lansoprazole, a newly developed proton pump inhibitor, and H2-receptor antagonists has shown a statistically significant difference for a higher healing rate with lansoprazole. In most of the comparative studies, the time to epigastric pain relief was shorter after receiving lansoprazole than after H2-receptor antagonists. In a single study comparing lansoprazole with omeprazole in 126 gastric ulcer patients, the healing rate at 8 weeks was significantly higher (P = 0.04) for lansoprazole than for omeprazole (93% vs 82%). In most studies comparing lansoprazole to H2-receptor antagonists in the treatment of duodenal ulcer, the healing rates at 4 weeks were significantly higher in the lansoprazole group. The time to achieve epigastric pain relief was significantly shorter with lansoprazole. In a single study comparing lansoprazole with omeprazole, ulcer healing rates at 2 weeks were significantly higher for lansoprazole (74% vs 58%) but not at 4 weeks (94% vs 94%). In conclusion, lansoprazole is more effective than H2-receptor antagonists in relieving ulcer pain and has a similar safety profile in the healing of gastric and duodenal ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)