Managed Healthcare Executive - December 2008 - (Page 26)

{ DRUG CLASS OVERVIEW } Peptic ulcers respond to acid-reducer medications Testing for H. pylori is the rst step, followed by PPIs and H2-receptor blockers coupled with lifestyle changes BY ELAINE ZABLOCKI Elaine Zablocki has been reporting on healthcare for more than a dozen years. 26 DECEMBER 2008 eptic ulcer disease a ects 10% of men and 4% of women in the United States at some point in their lives. The two most common causes are the use of nonsteroidal anti-in ammatory drugs (NSAIDs) and infection with Helicobacter pylori (H. pylori ) bacteria. The primary treatments for peptic ulcers are medications that suppress the ow of gastric acid, together with antibiotics to eradicate H. pylori. The rst step is to nd out whether H. pylori is present. A number of di erent tests are used, including the urea breath test, stool antigen test and an endoscopic biopsy. The standard treatment for this bacteria includes various combinations of two or three antimicrobial drugs. “When patients with active peptic ulcers are infected with H. pylori, eradication of the infection with antibacterial drugs markedly decreases the incidence of recurrence,” says Mark Abramowicz, MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-pro t newsletter that critically appraises drugs. In general, gastroenterologists are aware of the need to test for H. pylori and treat it appropriately, says Michael J. Tocco, RPh, MEd, president of Integrated Pharmacy Solutions Inc. in Stoneham, Mass. “General practitioners today are often not as aggressive in seeking and treating H. pylori, especially in the elderly,” he says. “The prevalence of this bacteria increases with age, so testing and treating elderly patients is essential.” A decade ago, Tocco was part of the team at the Institute of Contemporary Pharmacy Research that developed a consensus phar- P macotherapy algorithm on the treatment of H. pylori. Patients with peptic ulcers should receive treatment with antisecretory drugs. The available options include proton pump inhibitors (PPIs) and H 2-receptor blockers. Standard doses of PPIs inhibit more than 90% of acid secretion. They are most e ective when taken 30 to 60 minutes before the rst meal of the day. Once-daily dosing is su cient, and tolerance does not occur with PPIs. “PPIs heal peptic ulcers more rapidly than H2-blockers or any other drug. Prilosec (omeprazole) generally is as e ective as any other PPI, and is available generically and over the counter,” says Dr. Abramowicz. H2-blockers are available over the counter and inhibit 50% to 80% of acid secretion. Continuous administration of H2-blockers does lead to pharmacologic tolerance and decreased e ectiveness over time. “Among H2-blockers, the low price of generic cimetidine probably does not outweigh its many adverse drug interactions,” says Dr. Abramowicz. Gastroesophageal re ux disease (GERD), which is the chronic re ux of acid into the esophagus, can lead to esophagitis, esophageal ulcers, and changes in the lining of the esophagus that increase the risk of developing cancer. Medical therapy for GERD is based on acid suppression. H2-blockers and antacids are used for patients with mild, intermittent symptoms, while treatment with a PPI is preferred for those with more severe disease. LIFESTYLE CHANGES “Proton pump inhibitors are the best therapy for treating peptic ulcer disease, but we nd their predominant use is for acid re ux esophagitis,” says Timothy Edison, MD, a board-certi ed gastroenterologist at A nity Medical Group, a multispecialty group in northeastern Wisconsin.

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Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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