Subject(s)
Anti-Ulcer Agents/history , Gastroesophageal Reflux/history , Histamine Antagonists/history , Peptic Ulcer/history , Proton Pump Inhibitors/history , Anti-Bacterial Agents/history , Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Drug Therapy, Combination , Gastric Acid/metabolism , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/etiology , Helicobacter Infections/complications , Helicobacter Infections/drug therapy , Helicobacter Infections/history , Helicobacter pylori , Histamine Antagonists/therapeutic use , History, 20th Century , Humans , Omeprazole/history , Omeprazole/therapeutic use , Peptic Ulcer/drug therapy , Peptic Ulcer/etiology , Peptic Ulcer/microbiology , Proton Pump Inhibitors/therapeutic use , United StatesABSTRACT
Gastroesophageal reflux disease (GERD) has evolved from a scarcely reported, little understood disease process just a century ago to a now highly prevalent disease with up to 25% of the population complaining of symptoms of reflux. Throughout history attempts have been made to delineate the esophagus and related pathologies, but it has not been until relatively recently that enough has been understood about its screening, diagnosis and treatment to make a substantial impact on sufferers. Although the use of antacids and thereafter histamine 2 receptor antagonists dramatically improved the management of GERD, it was the advent of the proton pump inhibitor (PPI) class of drugs that revolutionized medical care. Although the relationship of hiatus hernia to reflux was well accepted, the modest results of open fundoplication fell into further disregard given the efficacy of PPIs. The PPIs are currently the most effective form of therapy and are equivalent on a milligram for milligram basis. While currently no novel drugs or devices are of proven efficacy for GERD, the development of an acid-suppressive agent of equal efficiency to a PPI but with a more rapid onset of action and a greater duration of effectiveness would be of particular clinical utility for the future.
Subject(s)
Anti-Ulcer Agents/history , Benzimidazoles/history , Gastroesophageal Reflux/history , Omeprazole/history , Sulfoxides/history , 2-Pyridinylmethylsulfinylbenzimidazoles , Anti-Ulcer Agents/therapeutic use , Benzimidazoles/therapeutic use , Esophagitis, Peptic/history , Esophagitis, Peptic/therapy , Gastroesophageal Reflux/therapy , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Omeprazole/therapeutic use , Pantoprazole , Postoperative Complications , Proton Pump Inhibitors , Sulfoxides/therapeutic useABSTRACT
Block buster drugs share a variety of common features, among which is the tendency to create entirely new markets. For example, an early "informed" estimate of the potential market size for the hypothetically "perfect" peptic ulcer drug was thirty-five million dollars. Based on current sales, however, we reckon this hypothesis to have underestimated the actual market demand for omeprazole (Prilosec) by about 400-fold. Similarly, prior to the introduction of the "retired" block busters chlordiazepoxide and diazepam (Librium and Valium), the market for "minor tranquilizers" in the treatment of anxiety and neurosis did not exist. Thus, once an emerging block buster seems to be therapeutically working, it is not unusual for diagnostic rates of the disease for which it is indicated and efficacious to actually increase. Top block buster drugs generally have or appear to have a high margin of safety.