Are proton pump inhibitors the first choice for acute treatment of gastric ulcers ?

Background: Gastric ulcers are a frequent problem in the United States. Proton pump inhibitors have been shown to increase healing rates and improve clinical symptoms. The objective of this study is to compare gastric ulcer healing rates for patients treated with a proton pump inhibitor (PPI) (omeprazole, rabeprazole, pantoprazole, or lansoprazole), an histamine 2receptor antagonist (ranitidine) or placebo. Methods: A literature search was conducted to identify randomized, controlled clinical trials that included a PPI in at least one treatment arm and assessed the gastric ulcer healing rates endoscopically. The healing rates were estimated for each treatment at specific time points, and Rate Ratios (RR) and 95% confidence intervals (CI) were estimated for each trial. Results: Sixteen trials met the inclusion criteria: four compared a PPI versus placebo, nine compared a PPI versus ranitidine (no trials of rabeprazole versus ranitidine met the inclusion criteria), and three compared a newer PPI (lansoprazole, pantoprazole or rabeprazole) versus omeprazole. In relation to ranitidine, the pooled RR of PPIs (lansoprazole, omeprazole and pantoprazole) was 1.33 (95% CI 1.24 to 1.42) at four weeks. In each trial, greater improvement in the studied clinical symptoms was found with the newer PPIs (rabeprazole, pantoprazole and lansoprazole) when compared to omeprazole. Conclusion: In this study treatment with PPIs resulted in higher healing rates than ranitidine or placebo. This evidence suggests that the first choice for gastric ulcer treatment for the greater relief of symptoms is one of the newer PPIs. Background In the United States about four million people have active peptic ulcers and about 350,000 new cases are diagnosed each year, and approximately 3000 deaths per year in the U.S. are due to gastric ulcer [1]. The primary therapeutic approach to gastric ulcer remains the inhibition of gastric acid secretion to produce symptom relief, acceleration of crater healing and the prevention of relapse or recurrence [2,3], since gastric ulcer can lead to hemorrhage, perforation, obstruction and death [4,5]. It is established that the H+, K+-ATPase, or proton pump, participates in the final step of acid secretion [6,7] and all the peripheral parietal cell stimuli converge to activate it Published: 15 July 2002 BMC Gastroenterology 2002, 2:17 Received: 22 March 2002 Accepted: 15 July 2002 This article is available from: http://www.biomedcentral.com/1471-230X/2/17 © 2002 Salas et al; licensee BioMed Central Ltd. Verbatim copying and redistribution of this article are permitted in any medium for any purpose, provided this notice is preserved along with the article's original URL.