Review article: drug development in gastroenterology--the changing view of industry.

Rationalization within the pharmaceutical industry to combat escalating costs has included the close examination of research portfolios. Gastroenterology has been one of the casualties of this exercise and few companies currently retain a specific gastrointestinal research programme. Acid-peptic disease has been the victim of its own success, since the availability of a range of extremely effective drugs largely satisfies current medical needs. A safe, convenient and effective monotherapy able to eradicate Helicobacter pylori would be a commercially viable alternative to antisecretory drugs, leading to further expansion of the anti-ulcer market. The irritable bowel syndrome is probably too diverse a target for logical research: inflammatory bowel disease is probably too small a market to be attractive. Potentially effective drugs to treat these and other gastrointestinal diseases could emerge from broader research programmes, provided that companies retain the expertise and desire to develop such agents for gastrointestinal indications. Cancer of the gastrointestinal tract and associated organs undoubtedly represents a commercially attractive target, but new anti-tumour drugs are more likely to arise from generic research rather than programmes specifically directed at tumours of the gastrointestinal tract. The changing view of the pharmaceutical industry towards the development of gastrointestinal drugs is likely to have a negative impact on both fundamental and clinical research in gastroenterology.