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The American Journal of Digestive Diseases

, Volume 4, Issue 6, pp 435–460 | Cite as

Antacids I. Comparative biochemical and economic considerations

  • Melvin Brody
  • William H. Bachrach
Review

Summary

1. Review of the literature on antacids indicates a scarcity of controlled clinical observations.

2. The acid-combining capacity of commercial antacid products was determined by titration with HCl. The data support the following observations:
  1. a.

    Products of similar chemical composition vary in their neutralizing capacity.

     
  2. b.

    Liquid preparations are generally more efficient than tablet preparations.

     
  3. c.

    Because rapid emptying is the principal factor impairing in vivo efficiency of acid neutralization by antacid, prompt reaction of antacid is an important prerequisite. Even products of similar compositions vary in their rate of reaction.

     
  4. d.

    The high cost of adequate neutralization is an important problem in effective ulcer management.

     
  5. e.

    Calcium carbonate, an inexpensive, rapid, potent acid neutralizer is the antacid of choice if care is taken to prevent constipation and if there is no predisposition to alkalosis, depression of renal function, or development of renal lithiasis.

     

5. All the above observations must be considered in light of the possibility that other qualities beside acid-neutralizing ability possessed by some of these products, may contribute to their clinical efficiency.

Keywords

Constipation Calcium Carbonate Important Prerequisite Principal Factor Renal Lithiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Grossman, M. I. The peptic digestion of living tissue. Editorial.Gastroenterology 8:678, 1947.Google Scholar
  2. 2.
    Christensen, L. K. Concerning thepH optimum of peptic hydrolysis.Arch. Biochem. 57:163, 1955.PubMedGoogle Scholar
  3. 3.
    Berk, J. E., Rehfuss, M. E., andThomas, J. E. In Situ effects of antacids in duodenal ulcer.A.M.A. Arch. Int. Med. 72:46, 1943.Google Scholar
  4. 4.
    Wosika, P. H., andEmery, E. S. The effectiveness of the Sippy regimen in neutralizing the gastric juice of patients if the amount of alkali is not varied.Ann. Int. Med. 9:1070, 1936.Google Scholar
  5. 5.
    Kirsner, J. B., andPalmer, W. L. The effect of various antacids upon the hydrogen ion concentration of the gastric contents,Am. J. Digest. Dis. 7:85, 1940.Google Scholar
  6. 6.
    Ivy, A. C., Grossman, M., andBachrach, W. H. Peptic Ulcer. New York, Blakiston, 1951.Google Scholar
  7. 7.
    Kirsner, J. B. A study of alkalosis with special reference to the electrolyte composition of the blood serum and the role of the kidney. PhD. thesis. Univ. of Chicago, Chicago, Ill., 1942.Google Scholar
  8. 8.
    McGee, L. C.,et al. The influence of alkalis on renal function.Am. J. Digest. Dis. 6:186, 1939.Google Scholar
  9. 9.
    Dufault, F. X., Jr., andTobias, G. J. Potentially reversible renal failure following excessive calcium and alkali intake in peptic ulcer therapy.Am. J. Med. 16:231, 1954.PubMedGoogle Scholar
  10. 10.
    Knapp, E. L. Factors influencing the urinary excretion of calcium: I. In normal persons.J. Clin. Invest. 26:182, 1947.Google Scholar
  11. 11.
    Block, L. andSerby, A. M. Use of alkalis in the treatment of peptic ulcer.J.A.M.A. 92:134, 1929.Google Scholar
  12. 12.
    Kretchmer, H. L., andBrown, R. C. Do alkalis used in the treatment of peptic ulcer cause kidney stones?J.A.M.A. 113:1471, 1939.Google Scholar
  13. 13.
    Eisele, C. W. The role of alkali therapy for peptic ulcer in the formation of urinary calculi.J.A.M.A. 114:2363, 1940.Google Scholar
  14. 14.
    Kleeman, C. Personal communication.Google Scholar
  15. 15.
    Kreider, H. R., Jr. The chemistry of aluminum hydroxide suspensions.J.A.M.A. 117:1356, 1941.Google Scholar
  16. 16.
    Ivy, A. C.,et al. The effect of aluminum preparations on the secretory activity and gastric acidity of the normal stomach.Am. J. Digest. Dis. 3:879, 1937.Google Scholar
  17. 17.
    Batterman, R. C., andEhrenfield, I. The ambulant treatment of the peptic ulcer syndrome: The comparative effectiveness and constipating action of antacids.Gastroenterology 9:141, 1947.Google Scholar
  18. 18.
    Boyd, L. H., Russ, W. R., andBarowsky, H. Non-reactive alumina in the treatment of peptic ulcer.Rev. Gastroenterol. 9:20, 1942.Google Scholar
  19. 19.
    Smith, F. H. Non-reactive aluminum hydroxide in the treatment of peptic ulcer.Gastroenterology 8:494, 1947.Google Scholar
  20. 20.
    Mutch, N. The silicate of magnesium.Brit. Med. J. 1:143, 1936.Google Scholar
  21. 21.
    Grote, I. W. andWoods, M. Studies on antacids: IV. Adsorption effects of various aluminum antacids upon simultaneously administered anticholinergic drugs.J. Am. Pharm. A. (Scient. Ed.) 42:319, 1953.Google Scholar
  22. 22.
    Goodman, L. S., andGilman, A. The Pharmaceutical Basis of Therapeutics. New York, Macmillan. 1951.Google Scholar
  23. 23.
    Adams, W. L., Einsel, I. H., andMyers, V. C. Aluminum hydroxide as antacid in peptic ulcer.Am. J. Digest. Dis. 3:112, 1936.Google Scholar
  24. 24.
    Quigley, J. P., Einsel, I. H., andMeschan, I. Some effects produced in the normal stomach by the ingestion of moderate and massive quantities of aluminum hydroxide gel.J. Lab. & Clin. Med. 24:485, 1939.Google Scholar
  25. 25.
    Komarov, S. A., andKomarov, O. The precipitability of pepsin by colloidal aluminum hydroxide.Am. J. Digest. Dis. 7:166, 1940.Google Scholar
  26. 26.
    Freeman, S., andIvy, A. C. The influence of antacids upon iron retention by the anemic rat.Am. J. Physiol. 137:706, 1942.Google Scholar
  27. 27.
    Hoffman, W. S., andDyniewiez, H. A. The effect of alumina gel upon the absorption of vitamin A from the intestinal tract.Gastroenterology 5:512, 1945.Google Scholar
  28. 28.
    Hoffman, W. S., andDyniewiez, H. A. The effect of alumina gel upon the absorption of amino acids, ascorbic acid, glucose, and neutral fat from the intestinal tract.Gastroenterology 6:50, 1946.Google Scholar
  29. 29.
    Beazall, J. M., Schmidt, C. R., andIvy, A. C. The effect of aluminum hydroxide cream on the absorption from the gastrointestinal tract.Am. J. Digest. Dis. 5:164, 1938.Google Scholar
  30. 30.
    Havens, W. P. Intestinal obstruction caused by aluminum hydroxide.J.A.M.A. 113:1564, 1939.Google Scholar
  31. 31.
    Steigmann, F., Hardt, L. L., andHyman, S. Antacids: Fact and fancy.Am. J. Digest. Dis. 19:310, 1952.PubMedGoogle Scholar
  32. 32.
    Rutherford, R. B., andEmery, E. S. The clinical effect of aluminum hydroxide on patients with peptic ulcer.New England J. Med. 220:407, 1939.Google Scholar
  33. 33.
    Emery, E. S., andRutherford, R. B. Further studies on the treatment of peptic ulcer with aluminum hydroxide gel.New England J. Med. 222:205, 1940.Google Scholar
  34. 34.
    Collins, E. N., Pritchett, C. P., andRossmiller, H. R. The use of aluminum hydroxide in the treatment of peptic ulcer.J.A.M.A. 116:109, 1941.Google Scholar
  35. 35.
    Woldman, E. E., andPolan, C. G. The value of aluminum hydroxide in the treatment of peptic ulcer.Am. J. M. Sc. 198:155, 1939.Google Scholar
  36. 36.
    Jones, C. R., Jr. Liquid colloidal aluminum hydroxide in the treatment of peptic ulcer.Pennsylvania M. J. 43:468, 1940.Google Scholar
  37. 37.
    McIntosh, J. F., andSutherland, C. G. The use of colloidal aluminum hydroxide in the treatment of peptic ulcer.Canad. M. A. J. 42:140, 1940.Google Scholar
  38. 38.
    Einsel, I. H., andRowland, V. C. The aluminum hydroxide treatment of peptic ulcer.Ohio S. M. J. 28:173, 1932.Google Scholar
  39. 39.
    Kyger, E. R., Jr., Hashinger, E. H., andWilhelmy, E. W. The treatment of peptic ulcer with colloidal aluminum hydroxide.Am. J. Digest. Dis. 6:363, 1939.Google Scholar
  40. 40.
    Einsel, I. H., Adams, W. L., andMyers, V. C. Aluminum hydroxide in the treatment of peptic ulcer.Am. J. Digest. Dis. 1:513, 1934.Google Scholar
  41. 41.
    Jones, C. R., Jr. Aluminum hydroxide in the treatment of peptic ulcer.Am. J. Digest. Dis. 4:99, 1937.Google Scholar
  42. 42.
    Wilkinson, S. A., andCommanduras, P. D. The treatment of peptic ulcer with aluminum hydroxide: A two year study.New England J. Med. 223:972, 1940.Google Scholar
  43. 43.
    Emery, E. S., andRutherford, R. B. Studies on the use of aluminum hydroxide gel in the treatment of peptic ulcer.Am. J. Digest. Dis. 5:486, 1938.Google Scholar
  44. 44.
    Mutch, N. Hydrated magnesium trisilicate in peptic ulceration.Brit. M. J. 1:254, 1936.Google Scholar
  45. 45.
    Mutch, N. Magnesium trisilicate.Brit. M. J. 2:735, 1937.Google Scholar
  46. 46.
    Kraemer, M. The use of hydrated trisilicate of magnesium for peptic ulcer.Am. J. Digest. Dis. 7:57, 1940.Google Scholar
  47. 47.
    Johnson, E. H., andDuncan, J. The chemical testing of antacids.Quart. J. Pharm. & Pharmacol. 18:251, 1945.Google Scholar
  48. 48.
    Kraemer, M. Magnesium trisilicate NNR. Its position among antacids used to treat peptic ulcer.Am. J. Digest. Dis. 8:56, 1941.Google Scholar
  49. 49.
    Holbert, J. M., Noble, N., andGrote, I. W. A study of antacid buffers: II. Prolonged neutralization.J. Am. Pharm. A. (Scient. Ed.) 37:292, 1948.Google Scholar
  50. 50.
    Kirsner, J. B. A further study of the effect of various antacids on the hydrogen ion concentration of the gastric contents.Am. J. Digest. Dis. 8:53, 1941.Google Scholar
  51. 51.
    Kurtz, P. The antacid properties of magnesium trisilicate in normal subjects and patients with peptic ulcer.J. Lab. & Clin. Med. 24:1015, 1939.Google Scholar
  52. 52.
    Silverman, D. N., andKatz, R. A. Treatment of peptic ulcer with a magma of magnesium trisilicate: Preliminary report.South. M. J. 34:638, 1941.Google Scholar
  53. 53.
    Tidmarsh, C. J., andBaxter, R. G. Magnesium trisilicate in the treatment of peptic ulcer.Canad. M. A. J. 39:358, 1938.Google Scholar
  54. 54.
    Reid, C. G. The control of gastric hyperacidity by magnesium trisilicate.Am. J. Digest. Dis. 6:267, 1939.Google Scholar
  55. 55.
    Levin, M. B. Peptic ulcer therapy.Am. J. Digest. Dis. 4:574, 1937.Google Scholar
  56. 56.
    Krantz, J. C., Kibler, D. U., andBell, F. K. The neutralization of gastric acidity with basic aluminum aminoacetate.J. Pharm. & Exper. Therapy. 82:247, 1944.Google Scholar
  57. 57.
    Reuling, J., Rossieu, A. X., andWolgel, M. I. A report on peptic ulcer therapy using a new antacid.Rev. Gastroenterol. 16:856, 1949.PubMedGoogle Scholar
  58. 58.
    Paul, W. D., andRhomberg, C. Medical management of peptic ulcer.J. Iowa M. Soc. 35:167, 1945.Google Scholar
  59. 59.
    Berry, L. H.,et al. Recent experimental and clinical experiences with antacid therapy in peptic ulcer.Am. J. Gastroenterol. 26:41, 1956.PubMedGoogle Scholar
  60. 60.
    Rider, J. A.,et al. DAA: Its antacid effect and use in peptic ulcer.Am. J. Digest. Dis. 1:287, 1956.PubMedGoogle Scholar
  61. 61.
    Fogelson, S. J. Gastric mucin treatment for peptic ulcer.A.M.A. Arch. Int. Med. 55:7, 1935.Google Scholar
  62. 62.
    Ivy, A. C. The physiology of mucus secretion with some experimental results on the prevention of ulcer with “gastric mucin”.Nebraska M. J. 17:317, 1932.Google Scholar
  63. 63.
    Glass, G. B. J., andBoyd, L. J. A study of the alleged deficiency of gastric mucin in the stomach of humans with peptic ulcer.Gastroenterology 16:697, 1950.PubMedGoogle Scholar
  64. 64.
    Babkin, B. P. Secretory Mechanism of the Digestive Glands. New York, Hoeber, 1950.Google Scholar
  65. 65.
    Mitchell, T. C. The buffer substances of the gastric juice and their relation to gastric mucus.J. Physiol. 73:427, 1931.Google Scholar
  66. 66.
    Jones, K. K., andIvy, A. C. Titration curve of gastric mucin.Proc. Soc. Exper. Biol. & Med. 29:219, 1931.Google Scholar
  67. 67.
    Kim, M. S., andIvy, A. C. The prevention of experimental duodenal ulcer by feeding neutral gastric mucin.J.A.M.A. 97:1511, 1931.Google Scholar
  68. 68.
    Orndorff, J. R., Fauley, G. B., andIvy, A. C. The prophylactic value of gastric mucin in the therapy of post-operative jejunal ulcer: An experimental study in dogs.Am. J. Digest. Dis. 3:26, 1937.Google Scholar
  69. 69.
    Reid, P. E., andIvy, A. C. Gastric mucin, a prophylactic against gastro-duodenal ulcer and “acute” toxicity resulting from cinchophen.Proc. Soc. Exper. Biol. & Med. 34:142, 1936.Google Scholar
  70. 70.
    Hardt, L. L., andBrodt, L. P. Aluminum hydroxide and magnesium trisilicate plus mucin in the treatment of peptic ulcer.A.M.A. Arch. Surg. 55:584, 1947.Google Scholar
  71. 71.
    Fogelson, S. J. The treatment of peptic ulcer: A preliminary report.J.A.M.A. 96:673, 1931.Google Scholar
  72. 72.
    Atkinson, A. J. Gastric mucin in the treatment of peptic ulcer.J.A.M.A. 98:1153, 1932.Google Scholar
  73. 73.
    Brown, C. F. G.,et al. Mucin therapy for peptic ulcer.J.A.M.A. 99:98, 1932.Google Scholar
  74. 74.
    Jones, K. K., Ivy, A. C., andAtkinson, A. J. The treatment of peptic ulcer with okrin: A preliminary report.Illinois M. J. 63:377, 1933.Google Scholar
  75. 75.
    Meyer, J., Seidman, E. E., andNecheles, H. The treatment of peptic ulcer with powdered okra.Illinois M. J. 64:339, 1933.Google Scholar
  76. 76.
    Atkinson, A. J. “Okrin” as an adjuvant in the treatment of peptic ulcer: Observations on 22 patients.Am. J. Digest. Dis. 1:713, 1934.Google Scholar
  77. 77.
    Adams, B. A., andHolmes, R. L. J. Soc. Chem. Ind. 54:1–6T, 1935.Google Scholar
  78. 78.
    Segal, H. L.,et al. A polyamine-formaldehyde resin.Gastroenterology 4:484, 1945.Google Scholar
  79. 79.
    Kraemer, M., andSiegal, L. H. Synthetic resin—a new antacid for the treatment of peptic ulcer.A.M.A. Arch. Surg. 56:318, 1948.Google Scholar
  80. 80.
    Martin, G. J., andWilkinson, J. The neutralization of gastric acidity with anion exchange resins.Gastroenterology 6:315, 1948.Google Scholar
  81. 81.
    Segal, H. L.,et al. A polyamine-formaldehyde resin.Am. J. Digest. Dis. 17:293, 1950.PubMedGoogle Scholar
  82. 82.
    Steigmann, F., andSchlesinger, R. B. A resin-gastric mucin mixture in the medical management of peptic ulcer.Am. J. Digest. Dis. 17:361, 1950.PubMedGoogle Scholar
  83. 83.
    Weiss, S., Espinal, R. B., andWeiss, J. Therapeutic application of anion exchange resins in the treatment of peptic ulcer.Rev. Gastroenterol. 16:501, 1949.Google Scholar
  84. 84.
    Spears, M. M., andPfeiffer, M. C. J. Anion exchange resins and peptic ulcer pain.Gastroenterology 8:191, 1947.Google Scholar
  85. 85.
    Wirts, C. W., andRehfuss, M. D. A study of the effect of an anion exchange resin on gastric and duodenal secretions and gastric emptying time.J. Clin. Invest. 29:39, 1950.Google Scholar
  86. 86.
    Kraemer, M., andLehman, D. J. The treatment of peptic ulcer with anion exchange resins.Gastroenterology 8:202, 1947.Google Scholar
  87. 87.
    Bergen, C. M., andGreenberg, A. Polyamine anion exchange resins in the management of peptic ulcer.New York J. Med. 50:1495, 1950.PubMedGoogle Scholar
  88. 88.
    Marks, J. A. An anion exchange resin for the medical management of peptic ulcer.Rev. Gastroenterol. 16:82, 1949.Google Scholar
  89. 89.
    Weiss, J. The treatment of gastric and duodenal ulcer with an anion exchange resin.Rev. Gastroenterol. 15:826, 1949.Google Scholar
  90. 90.
    Karsdon, S. C. Anion exchange resins in the treatment of heartburn during pregnancy.New England J. Med. 239:575, 1948.Google Scholar
  91. 91.
    Wirts, C. W., Sullivan, B. H., andHemmerly, W. C. A comparison of an anion exchange resin and aluminum hydroxide gel in the treatment of peptic ulcer.Gastroenterology 15:1, 1950.PubMedGoogle Scholar
  92. 92.
    Hall, A. A., andHornisher, C. J. The effect of anion exchange resin on the healing time of duodenal ulcer craters.Gastroenterology 16:181, 1950.PubMedGoogle Scholar
  93. 93.
    Necheles, H.,et al. Peptic ulcer in man. IV. A new antacid made to meet the requirements of antacid therapy. Chemical and laboratory work.Am. J. Digest. Dis. 18:1, 1951.PubMedGoogle Scholar
  94. 94.
    Necheles, H.,et al. Peptic ulcer in man: V. A new antacid, SCMC, made to meet the requirements of antacid therapy. Clinical evaluation.Am. J. Digest. Dis. 18:7, 1951.PubMedGoogle Scholar
  95. 95.
    Brick, I. B. Experiences with SCMC as an antacid.Am. J. Digest. Dis. 16:315 1949.Google Scholar
  96. 96.
    Schultz, J. Carboxymethylcellulose as a colloid laxative.Am. J. Digest. Dis. 16:319, 1949.Google Scholar
  97. 97.
    Rossett, N. E., andFlexner, J. A method for the continuous recording of gastricpH in situ: IV. Further evaluation of the efficacy of antacids in vitro and in the human being.Ann. Int. Med. 18:193, 1943.Google Scholar
  98. 98.
    Rossett, N. E., andRice, M. L. An in vitro evaluation of the efficacy of the more frequently used antacids with particular attention to tablets.Gastroenterology 26:490, 1954.Google Scholar
  99. 99.
    Bralow, S. P.,et al. Peptic ulcer in man: II. The status of ulcer therapy.Am. J. Digest. Dis. 17:86, 1950.Google Scholar
  100. 100.
    Murphy, R. S. In vitro differences between dihydroxyaluminum aminoacetate and dried aluminum hydroxide gel.J. Am. Pharm. A. (Scient. Ed.) 41:361, 1952.Google Scholar
  101. 101.
    Kirsner, J. B., andFord, H. The gastric secretory response to histalog: One-hour basal and histalog secretion in normal persons and in patients with duodenal ulcer and gastric ulcer.J. Lab. & Clin. Med. 46:307, 1955.Google Scholar

Copyright information

© Paul B. Hoeber, Inc. 1959

Authors and Affiliations

  • Melvin Brody
    • 1
    • 2
  • William H. Bachrach
    • 1
    • 2
  1. 1.From Wadsworth GM&S Hospital, Veterans Administration CenterLos Angeles 25
  2. 2.the University of Southern California School of MedicineUSA

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