History of Antiulcer Drugs


The therapy of peptic ulcer disease has progressively changed in the last two centuries. Major discoveries were achieved by the possibility to directly visualize the first part of the gastrointestinal tract with endoscopy and by the availability of potent antisecretory agents. Then, since Helicobacter pylori was discovered, the cause of this disease was understood and the optimal therapy was found. The cure of the infection was not only able to heal the ulcer but also to cure the disease, interrupting its relapsing behaviour. Initially, dual therapy, a combination of a proton pump inhibitor with an antibiotic, demonstrated an overall efficacy for the eradication of H. pylori better than monotherapy, but still not satisfactory. Finally, a triple therapy of proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole, has been the most widely recommended eradication treatment.

Key concepts

  • Neutralization of gastric acidity heals peptic ulcer but does not prevent relapse of Helicobacter pyloriÔÇÉrelated ulcer.

  • H. pylori has been clearly related to gastritis, peptic ulcer (gastric and duodenal ulcer), gastric lymphoma and cancer.

  • Eradication of H. pylori infection heals and prevents the peptic ulcer relapse.

  • The triple therapy of proton pump inhibitor and two antibiotics (clarithromycin and either amoxicillin or metronidazole) is the most widely recommended eradication treatment for H. pylori infection.

Keywords: peptic ulcer disease; therapy; Helicobacter pylori

Further Reading

Bazzoli F, Zagari RM, Fossi S et al. (1994) Short‐term low dose triple therapy for the eradication of Helicobacter pylori. European Journal of Gastroenterology and Hepatology 6: 773–777.

Bizzozero G (1892) Sulle ghiandole tubulari del tubo gastro‐enterico e sui rapporti del loro epitelio coll'epitelio di rivestimento della mucosa. Atti della Reale Accademia delle Scienze di Torino 28: 233–251.

Black JW, Duncan WAM, Durant CJ, Ganellin CR and Parsons EM (1972) Definition and antagonisms of histamine H2 receptors. Nature 236: 385–390.

Chey WD and Wong BCY (2007) American College of Gastroenterology. Guideline on the management of Helicobacter pylori infection. American Journal of Gastroenterology 102: 1808–1825.

Davenport HW (1992) A History of Gastric Secretion and Digestion, p. 414. Oxford: Oxford University Press.

Fuccio L, Laterza L, Zagari RM et al. (2008) Treatment of Helicobacter pylori infection. BMJ 337: 746–750.

Fuccio L, Zagari RM and Bazzoli F (2008) What is the best salvage therapy for patients with Helicobacter pylori infection? Nature Clinical Practice. Gastroenterology & Hepatology 5(11): 608–609.

Ivy AC, Grossman M and Bachrach WH (1950) Peptic Ulcer, p. 1144. Philadelphia: The Blakiston Co.

Malfertheiner P, Megraud F, O'Morain C et al. (2007) Current concepts in the management of Helicobacter pylori infection: the Maastricht III consensus report. Gut 56: 772–781.

Thomas R (1819) The Modern Practice of Physic, 6th edn, p. 914. London: Longman Hurst.

Warren JR and Marshall B (1983) Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1: 1273–1275.

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Fuccio, Lorenzo, Leonardo Henry, Eusebi, and Bazzoli, Franco(Sep 2009) History of Antiulcer Drugs. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0003629.pub2]