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Optimizing acid suppression for treatment of acid-related diseases

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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.

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Authors and Affiliations

  1. Division of Gastroenterology, McMaster University Medical Center, 1200 Main Street West, Room 4W8, L8N 3Z5, Hamilton, Ontario, Canada

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

  2. Astra Hässle AB, Mölndal, Sweden

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

  3. Gastroenterology Unit, Royal Adelaide Hospital, Adelaide, Australia

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

  4. Gastrointestinal Unit, Inselspital, University of Bern, Bern, Switzerland

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

  5. Division of Digestive Diseases and Nutrition, Richland Medical Park, Columbia, South Carolina, USA

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

  6. Gastro-Intestinal Clinic, Groote Schuur Hospital Observatory, South Africa

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

  7. Glostrup Hospital, Glostrup, Denmark

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

  8. Queen Elizabeth Hospital, Birmingham, UK

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

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  1. Richard H. Hunt
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Hunt, R.H., Cederberg, C., Dent, J. et al. Optimizing acid suppression for treatment of acid-related diseases. Digest Dis Sci 40 (Suppl 2), 24S–49S (1995). https://doi.org/10.1007/BF02214870

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