Less than 2 centuries have elapsed since the identification of hydrochloric acid in
the stomach. The clarification of the molecular mechanisms allowed the effective therapeutic
suppression of gastric acid secretion. The spectacular advances in the treatment of
acid-related disorders represent a synthesis of the contributions of several brilliant
pharmacologists, basic scientists, and clinical physicians. Effective gastric acid
suppressive therapy has dramatically improved the therapy and outcome of acid-related
disorders. The introduction of proton pump inhibitors (PPIs) in clinical practice
has significantly changed the medical management of upper gastrointestinal disorders.
PPIs represent the "gold-standard" therapy in acid-related disorders. However, some
challenges persist in the therapy of acid related diseases, including management of
patients who respond inadequately to PPI therapy, more effective gastroprotection,
or more powerful antisecretory treatment for the eradication of Helicobacter pylori
infection. New antisecretory drugs are currently being developed and investigated
to further provide a more effective and profound gastric acid secretion inhibition.
The major advance has been the development of acid pump -antagonists, the potassium
channel acid blocking drugs (-P-CABs). Long-term studies comparing P-CABs with PPIs
will help to define the exact place and safety profile of this class of drug in the
management of acid-related disorders.
