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Gastritis and peptic ulcer disease 217
The following chapter (on GERD) outlines some potential age-specific
preferences for certain PPIs, but there is limited evidence on the topic as
relates to GPUD. The various available PPIs do come in different formula-
tions, but the clinical significance of different formulations is yet to be fully
elucidated. 21
Overviews of the PPIs note that these agents are effective in many patients
who are poorly responsive to H2-receptor antagonists. 22 The PPIs also
relieve symptoms better than does the gastroprotective agent sucralfate.
Data from a RCT comparing omeprazole (40 mg PO QD) and sucralfate
(2 g PO BID) indicated superior symptom relief with omeprazole after a
two week follow-up assessment; the PPI also reduced symptom recurrence. 23
The improvements in both symptom reduction and relapse rates with the PPI
contributed to conclusions that primary use of this class is cost effective. 22
Finally, the PPIs are preferable to the H2-receptor antagonists for combination
with antibiotics to achieve GPUD symptom relief (and cure) via eradication
of H. pylori. 24
Although not as effective as the PPIs, sucralfate (1 g PO TID, or 1 g PO
before meals and at bedtime) has efficacy that is good and approximately
equal to that of the H2-receptor antagonists. Data from RCTs show that
sucralfate use provides ulcer pain relief in the same proportion of patients
(nearly 80%) as H2-receptor antagonists such as ranitidine (150 mg PO
BID). 25,26 Compared with H2-receptor antagonists, sucralfate does appear
to be associated with slightly more side effects (particularly constipation),
and sucralfate’s effect on absorption of other medications may be a consideration
in some patients. 26
Sucralfate’s efficacy appears to be unrelated to its formulation. For relief of
gastritis symptoms, a BID regimen of sucralfate gel is as effective as the
standard QID regimen of sucralfate suspension. 27
For acid-related pain, the inferiority of H2-receptor antagonists to PPIs
may be because the former agents block only one gastric parietal cell acid
secretion mechanism (i.e. the histaminic). Compared with sucralfate, the
H2-receptor antagonist ranitidine (150 mg PO BID) provides similar pain
relief, with potentially better early symptom relief (i.e. improvement during
the initial weeks of follow-up). 25 Trials have found that H2-receptor