Is there a role for antacids in the modern management of peptic ulcers?

Abstract

Antacids have been a very useful and effective class of drugs for the treatment of peptic ulcers for over a century, but have been overlooked in recent years. They are effective, safe and economical. In 13 randomised, controlled trials with endoscopic evidence of healing as the end-point, antacids heal 74% of duodenal ulcers in 4 weeks. The evidence for their efficacy in healing gastric ulcers is less strong. For maximal efficacy, adequate doses (e.g., an acid neutralising capacity > 400 mmol/day) need to be taken not intermittently but regularly, several times a day after meals. This regimen may lead to problems with compliance. Tablet forms are more convenient and are as effective as liquid forms. Liquid antacid is of proven value in the prophylaxis of stress ulcer bleeding. Certain antacids may be cytoprotective and more basic research is needed in this area. At the same time, the inclusion of antacids in therapeutic regimens for the healing and prevention of peptic ulcers, and for symptomatic relief during and after eradication of Helicobacter pylori should be explored. Due to their low production costs, antacids have a definite role in developing countries.