Acid Suppression Therapy: Where Do We Go from Here?
Abstract
The dramatic success of pharmacological acid suppression in healing peptic ulcers and managing patients with gastroesophageal reflux disease (GERD) has been reflected in the virtual abolition of elective surgery for ulcer disease, a reduction in nonsteroidal anti-inflammatory drug (NSAID)-associated gastropathy and the decision by most patients with reflux symptoms to continue medical therapy rather than undergo surgical intervention. However, a number of challenges remain in the management of acid-related disorders. These include management of patients with gastroesophageal symptoms who do not respond adequately to proton pump inhibitor (PPI) therapy, treatment of patients with nonvariceal upper gastrointestinal bleeding, prevention of stress-related mucosal bleeding, optimal treatment and prevention of NSAID-related gastrointestinal injury, and optimal combination of antisecretory and antibiotic therapy for the eradication of Helicobacter pylori infection. A number of new drugs are currently being investigated to provide a significant advance on current treatments. Some of them (namely potassium-competitive acid blockers (P-CABs) and CCK 2-receptor antagonists) have already reached clinical testing while some others (like the antigastrin vaccine, H 3-receptor ligands or gastrin-releasing peptide receptor antagonists) are still in preclinical development and need the proof of concept in human beings. Of the current approaches to reduce acid secretion, P-CABs and CCK 2-receptor antagonists hold the greatest promise, with several compounds already in clinical trials. Although the quick onset of action of P-CABs (i.e. a full effect from the first dose) is appealing, the results of phase II studies with one such agent (namely AZD0865) did not show any advantages over esomeprazole. Thanks to their limited efficacy and the development of tolerance it is unlikely that CCK 2 antagonists will be used alone as antisecretory compounds but, rather, their combination with PPIs will be attempted with the aim of reducing the long-term consequences of hypergastrinemia. While H 2-receptor antagonists (especially soluble or over-the-counter formulations) will become the ‘antacids of the third millennium’ and will be particularly useful for on-demand symptom relief, clinicians will continue to rely on PPIs to control acid secretion in GERD and other acid-related diseases. In this connection, several new PPI formulations have been developed and two novel drugs (namely ilaprazole and tenatoprazole) are being studied in humans. The recently introduced immediate-release (IR) omeprazole formulation (currently available only in the USA) quickly increases intragastric pH and, given at bedtime, seems to achieve a better control of nocturnal acidity. IR formulations of other PPIs (including the investigational ones) will probably be available in the future and will enlarge our therapeutic armamentarium. Amongst the novel PPIs, tenatoprazole appears to be a true advance in the acid suppression therapy. Its long half-life (the longest among the available compounds) and longer duration of antisecretory action, with no difference between day and night, will allow the drug to go beyond the intrinsic limitations of currently available PPIs. Thanks to its favorable pharmacokinetics, the sodium salt of S-tenatoprazole is being developed and the preliminary results indicate that this drug has the potential to address unmet clinical needs. Although some decades have elapsed since the introduction of effective and safe antisecretory drugs in clinical practice and their use has stood the test of time, the ongoing research will further provide the clinician with more effective means of controlling acid secretion.
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Proton pump inhibitors (PPIs) are acid-suppressive agents and are among the most widely used and over-used drugs in the world.
“Proton pump inhibitors (PPIs) are acid-suppressive agents and are among the most widely used and over-used drugs in the world[1].”
From Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified (2019) · cites this paper as [1]
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- Authors
- Scarpignato, C., Pelosini, I., & Di Mario, F.
- Affiliations
- University of Parma (IT)
- ORCID
- Scarpignato, Carmelo
- Venue
- Digestive Diseases
- Publisher
- S. Karger AG
- Published
- 2006
- Volume
- 24
- Issue
- 1-2
- Pages
- 11-46
- ISSN
- 0257-2753 (ISSN-L)
- 1421-9875
- OpenAlex
- W2091449127
- Cited by
- 119
- References
- 284
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 4 · 2022: 11 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 5 · 2012: 2
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Digestive Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- acid suppression, proton pump inhibitors, gastroesophageal reflux disease, peptic ulcer healing, non-variceal upper gastrointestinal bleeding, NSAID-induced gastropathy, Helicobacter pylori eradication, potassium-competitive acid blocker, H2 receptor antagonists, histamine H3 receptor antagonists, hypergastrinemia, omeprazole
- MeSH terms
- Anti-Ulcer Agents, Enzyme Inhibitors, Gastric Acid, Gastroesophageal Reflux, Histamine H2 Antagonists, Humans, Treatment Outcome, Proton Pump Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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