Drug company executives are getting nervous about the potential collapse of a $5 billion market in ulcer medicine.
Highly profitable drugs such as Zantac, Tagamet, Pepcid and Prilosec are threatened by new research suggesting many ulcers are caused by infection instead of stress.
For decades doctors were trained to believe "no acid, no ulcer." The ulcer-prone personality was characterized as a high-pressure, type-A individual driven in his career. Typically he (or she) would carry Maalox, Mylanta or Tums wherever he went.
Physicians relied heavily on antacid treatment for their ulcer patients until the acid-suppressing drugs came along. Then prescription medications such as Tagamet and Zantac took off like rockets. Within a few years, they became the most successful medicines in the history of the pharmaceutical industry. Zantac alone earns well in excess of $3 billion annually.
Now experts in the field of gastroenterology have concluded that many ulcers are due to a bacterium called Helicobacter pylori. A consensus panel of experts, convened by the National Institutes of Health, recently concluded that treatment with antibiotics for two weeks was more effective than years of acid-suppression therapy.
Reducing acid in the stomach helps relieve pain and speeds ulcer healing.
When drugs such as Tagamet, Zantac, Pepcid or Prilosec are discontinued, however, ulcers often recur.
That is why people are commonly put on maintenance therapy. Every evening they swallow their pill just to make sure the ulcer won't come back.
But the price can be prohibitive. Dr. Amnon Sonnenberg, a gastroenterologist at the Medical College of Wisconsin, estimates that 15 years of such therapy could cost a patient up to $11,500.
Triple therapy with anti-bacterial drugs such as metronidazole (Flagyl), tetracycline and Pepto-Bismol for a week or two would cost a small fraction of that sum and produce far more lasting results.
Another advance that has drug company executives worried is a new medicine for heartburn. Many prescriptions for Zantac and Tagamet are for people with acid reflux. This splashback of acid from the stomach into the esophagus causes the discomfort associated with heartburn.
Instead of trying to neutralize or suppress acid, doctors now have the option of prescribing Propulsid (cisapride), which tightens the sphincter muscle separating the stomach from the esophagus. This keeps the acid in the stomach where it belongs.
We have prepared a brochure which details these new treatments for ulcers and indigestion. It discusses advantages and problems with Axid, Pepcid, Prilosec, Tagamet and Zantac.
Anyone who would like a copy of Graedons' Guide to Digestive Disorders, please send $2 with a long (No. 10) stamped, self-addressed envelope to: Graedons' People's Pharmacy, No. G-3, P.O. Box 52027, Durham, NC 27717-2027.
It has taken the gastroenterology gurus a long time to evaluate these new approaches to digestive distress. Now that the experts have spoken and recommended anti-bacterial treatment for ulcers, patients should be able to save money and heal their ulcers more effectively.
Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.