Is there an optimal degree of acid suppression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression

The optimal degree and duration of suppression of gastric acidity required for the healing of peptic ulcers has never been established. Although very potent inhibitors of acid secretion are now available, the need for this degree of suppression has not been shown, and there is a possibility of adverse effects because of pronounced acid inhibition. Therefore, a model has been constructed that defines the relationship between duodenal ulcer healing and antisecretory therapy. Acid suppression data were obtained directly from investigators as raw data from 24-hour studies of acid secretion. Twenty-one experiments from seven investigators provided 490 24-hour studies using 19 different treatment regimens. Healing data were collected from a metaanalysis of published clinical trials of duodenal ulcer healing. A total of 144 published trials in 14,208 patients provided healing data at several endoscopic endpoints for the 19 drug regimens for which acidity data were provided. Weighted least-squares polynomial regression analysis was used to define those parameters of antisecretory therapy that contributed most to duodenal ulcer healing and to define the shape of the response surface. A highly significant correlation (r = 0.9814) was found between healing and the degree of acid suppression, the duration of acid suppression, and the length of therapy. The shape of the contour expression this relationship shows that healing increases as the duration of suppression increases and as gastric pH increases. However, suppression that increased pH beyond 3.0 was not found to increase ulcer healing further. It is concluded that a longer duration of antisecretory effect and/or a longer duration of therapy are of greater importance than potency for duodenal ulcer healing.