Optimizing acid suppression for treatment of acid-related diseases

Richard H. Hunt, Christer Cederberg, John Dent, Fred Halter, Colin Howden, I. N.Solly Marks, Simon Rune, Robert P. Walt

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Gastric acid is of central importance in the pathogenesis of duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. Pharmacological reduction of acid secretion is, therefore, the mainstay of current treatment, but the optimal degree of acid suppression remains incompletely understood. This paper considers the ideal ways of assessing and reporting the pharmacological effectiveness of acid-inhibiting drugs and relating such data to clinical efficacy. Twenty-four-hour intragastric pH measurements are widely used for this purpose, although this technique cannot measure secretion quantitatively. Data on suppression of 24-hr intragastric acidity for groups of subjects have been successfully correlated with healing rates for duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. Three primary determinants of healing have been derived from antisecretory data. These are the degree of suppression of acidity, the duration of suppression of acidity, and the duration of treatment. The order of importance of these determinants varies depending on the disease. Data on 24-hr intragastric acidity should be accompanied whenever possible by data on 24-hr plasma gastrin levels, as the relationship between suppression of acidity and a rise in gastrin varies widely between individuals. It is not possible to predict the plasma gastrin level from the intragastric pH or any other measurement of intragastric acidity. Comparative data sets in groups of subjects may provide useful information. Proton pump inhibitors produce a greater and longer-lasting degree of suppression of acidity than conventional doses of H2-receptor antagonists. For this reason, they are more effective in healing duodenal ulcer and gastric ulcer. However, in view of the importance of duration of treatment, healing rates with the H2-receptor antagonists approach those obtained with proton pump inhibitors if treatment is continued for a longer time. In gastroesophageal reflux disease in particular, although the optimal degree of acid suppression is not yet defined, the consistently superior performance of proton pump inhibitors demonstrates that increased suppression of acidity is clinically beneficial.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
Volume40
Issue number2 Supplement
DOIs
StatePublished - Feb 1 1995

Fingerprint

Proton Pump Inhibitors
Gastrins
Stomach Ulcer
Duodenal Ulcer
Gastroesophageal Reflux
Histamine H2 Receptors
Acids
Pharmacology
Gastric Acid
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Hunt, R. H., Cederberg, C., Dent, J., Halter, F., Howden, C., Marks, I. N. S., ... Walt, R. P. (1995). Optimizing acid suppression for treatment of acid-related diseases. Digestive Diseases and Sciences, 40(2 Supplement). https://doi.org/10.1007/BF02214870

Optimizing acid suppression for treatment of acid-related diseases. / Hunt, Richard H.; Cederberg, Christer; Dent, John; Halter, Fred; Howden, Colin; Marks, I. N.Solly; Rune, Simon; Walt, Robert P.

In: Digestive Diseases and Sciences, Vol. 40, No. 2 Supplement, 01.02.1995.

Research output: Contribution to journalArticle

Hunt, RH, Cederberg, C, Dent, J, Halter, F, Howden, C, Marks, INS, Rune, S & Walt, RP 1995, 'Optimizing acid suppression for treatment of acid-related diseases', Digestive Diseases and Sciences, vol. 40, no. 2 Supplement. https://doi.org/10.1007/BF02214870
Hunt, Richard H. ; Cederberg, Christer ; Dent, John ; Halter, Fred ; Howden, Colin ; Marks, I. N.Solly ; Rune, Simon ; Walt, Robert P. / Optimizing acid suppression for treatment of acid-related diseases. In: Digestive Diseases and Sciences. 1995 ; Vol. 40, No. 2 Supplement.
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