PubMed · 7429131
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1980. Scanning for acid.. https://pubmed.ncbi.nlm.nih.gov/7429131/
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The (re)discovery of the gastric pathogen Helicobacter pylori almost one and a half decade ago completely changed our conception on gastroduodenal ulcer disease and gastric cancer. The most important issue is that Helicobacter pylori induces a mild, antrum dominant chronic pangastritis without increased risk of severe diseases in most of the cases. A smaller part of the infected develops antrum dominant gastritis with increased risk of duodenal ulcer. In a few cases the corpus is also affected, pangastritis occurs with increased risk to develop gastric ulcer and gastric cancer. Until now it is not quite obvious why some of the infected patients get ill while others not, and why different diseases develop in different patients. 1. From the bacterial point of view it is ascertained that toxin-producing strains (VacA, CagA positive) are more likely to induce ulcer formation and gastric carcinoma. 2. Genetic phenotype of the infected patients (blood-group and HLA antigens) may also be of importance. 3. Environmental factors may affect (promote or inhibit) disease development. All of these factors determine the complex immunological, functional and morphological changes characteristic for the developing disease.
Gastric acid-related disorders are common clinical problems associated with a wide range of symptoms. Important advances have occurred over the last 20 yr that have improved our understanding of these disorders as well as our approach to treatment. Today, control of gastric acid secretion represents the cornerstone of effective management of both peptic ulcer disease and gastroesophageal reflux disease (GERD). A variety of acid-reducing strategies are now available to clinicians to manage symptoms and control or resolve disease. Antacids offer rapid symptomatic relief but probably have little effect on overall disease progression. Histamine-2 receptor antagonists can also provide good initial symptomatic treatment in peptic ulcer disease and in mild to moderate GERD. However, problems with postmeal acid control and tachyphylaxis may detract from their long-term usefulness. The availability of proton pump inhibitors (PPIs), which block the final process in H+ ion secretion, has revolutionized our approach to the management of patients with acid secretory disorders. The currently available PPIs, omeprazole and lansoprazole, enable us to control symptoms effectively and safely, hasten healing, and minimize disease recurrence. New PPIs, such as rabeprazole and pantoprazole, will further expand our treatment options and may offer even greater possibilities with regard to rapid symptomatic relief and disease resolution.
BACKGROUND: The majority of patients who have symptomatic acid reflux disease will have a normal oesophageal mucosa or will have only a mild degree of oesophagitis. Treatment to relieve symptoms as they occur may be the best way to manage these patients, to whom the speed of symptom relief is of primary importance. The effervescent complex used to formulate effervescent ranitidine contains sodium bicarbonate and monosodium citrate, and has, therefore, an intrinsic acid-neutralizing capacity in addition to the well-documented antisecretory activity. METHODS: The results of studies of the effects of effervescent ranitidine tablets on intragastric pH and on the relief of heartburn are reviewed. RESULTS AND CONCLUSIONS: When compared with the standard ranitidine tablet, the effervescent formulation results in a significantly greater and more rapid rise in intragastric pH in the hour immediately after dosing. Comparative studies show that intragastric pH is raised significantly faster after a single dose of effervescent ranitidine than after a famotidine rapid release tablet and after either an omeprazole or a lansoprazole capsule. In patients with acid reflux disease, effervescent ranitidine provides quicker relief of symptoms than a standard tablet and is preferred by most patients for this reason. The majority of patients (more than 80%) report symptom relief within 60 min of taking effervescent ranitidine.