By Rachel Pugh
A revolution in the treatment of peptic ulcers over the past 50 years has transformed it from a common illness which once led to haemorrhage and death, to a condition controlled by mass self-medication with proton-pump inhibitors (PPIs) available at petrol stations and supermarkets.
The historical journey looking at the major advances in the understanding of duodenal ulceration was the subject of the Sir Michael Perrin plenary session at the Royal College of Physicians’ 2018 annual conference.
Professor John Atherton, Dean of Nottingham University Medical School in the United Kingdom, described the discovery of the Helicobacter pylori bacterium underlying peptic ulceration as ‘the biggest revolution in gastrointestinal (GI) medicine’. He said: “We now treat ulcers using acid suppressants and antibiotics. This not only heals ulcers but prevents their recurrence. It cures the disease.”
One of three experts speaking on the subject, he pointed out that H pylori has also been shown to be the cause of more than 80% of cases of gastric adenocarcinoma, the third biggest cancer killer in the world.
Professor Atherton said: “If we could solve the worldwide public health problem of H pylori infection, we could prevent this disease too.”
Preceding him, Professor Roy Pounder, Emeritus of Medicine at University College London, outlined the peptic ulcer picture 50 years ago, when up to 10% of men (fewer women) suffered recurrent epigastric pain, haemorrhage and often death, with few solutions other than antacids and bed rest, or expensive and risky surgery.
The synthesis of the histamine H2 receptor antagonists in the early 1970s led to the launch of cimetidine in the United Kingdom in 1976 which not only speeded healing of acute ulcers but also prevented their recurrence. The first PPI omeprazole, described in 1979, produced virtual gastric anacidity in a single daily oral dose, with speedy benefits for both peptic ulceration and reflux oesophagitis.
The picture is not straightforward however. Dr. Paul Moayyedi, Director of the Gastroenterology division at McMaster University, Canada, examined recent associations made between PPIs and a range of conditions including pneumonia, fracture, heart disease and Clostridium difficile infection , which he sees as the product of powerful data analysis.
He said: “Researchers need to be more cautious in interpreting modest associations.”