Acid-peptic disease

Because the antimuscarinic drugs slow gastric emptying, they may increase symptoms in patients with gastric ulcer. Nonselective antimuscarinic agents should never be used to treat acid-peptic disease (see Chapter 62). 

Feldman M, Burton ME. Histaminel-receptor antagonists. Standard therapy for acid-peptic diseases. 1. N Engl J Med 1990 323(24) 1672-80. 

The results of a therapeutic interchange program, in which 78 patients with acid peptic disease requiring proton pump inhibitor therapy (both newly diagnosed patients and those previously stabilized on omeprazole) were treated with lansoprazole, have been retrospectively analysed (12). Although the switch was associated with considerable pharmaceutical savings, there was an overall lansoprazole-associated failure rate of 28%. Reported lack of efficacy required withdrawal of lansoprazole in 15%, while adverse effects required withdrawal of lansoprazole in 13% of patients (versus none with omeprazole). The main adverse effect was diarrhea. 

Calcuti. C.R. et a/. (1988) Zolantidlne (SK F 95282) is a potent selective brain-penetrating histamine Hj receptor antagonist. Br. J. Pharmacol.. 93,69-78. Feldman. M. et al. (1990) Hlstamlnea-receptor antagonists. Standard therapy for acid-peptic diseases (1). N. Engl.J. Med.. 323.1672-1680. 

Welage LS, Berardi RB. Drug interactions with antiulcer agents Considerations in the treatment of acid-peptic disease. J Pharm Pract 1994 7 177-195. 

Acid peptic disease (overall less effective than proton pump inhibitors), gastroesophageal reflux dystrophy (GERD), Zollinger-Ellison syndrome. 

Figure VI-1-1. Drug Actions in Acid Peptic Disease...

GASTROINTESTINAL TRACT In the management of acid-peptic disease, antisecretory doses of muscarinic antagonists produce hmiting side effects (Table 7-2) and, consequently, poor patient compliance. Pirenzepine has selectivity for Mj over and M3 receptors. However, piren-zepine s affinities for Mj and receptors are comparable, so it does not possess total Mj selectivity. 

The Hj receptor antagonists were the first truly effective drugs for the therapy of acid-peptic disease, and their long history of safety and efficacy with the eventually led to their avaUabihty without a prescription. Increasingly, proton pump inhibitors (some also available OTC) are replacing the Hj receptor antagonists in cUnical practice. 

Gut Atropine, methscopolamine, and propantheline were used in acid-peptic disease to reduce acid secretion, but they are not as effective as H,-blockers such as cimetidine, and they cause far more frequent and severe adverse effects. Pirenzepine is an M -selective muscarinic blocker (available in Europe but not tbe USA) that may be more useful in peptic ulcer. Muscarinic blockers can also be used to reduce cramping and hypermotility in transient diarrheas, but opioids such as diphenoxylate (Chapter 31) are more effective. 

Acid-peptic disease Disease of the upper digestive tract caused by acid and pepsin includes erosions and uicers... 

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