A world leader in gastrointestinal medicines

Acid-related diseases, such as gastro oesophageal reflux disease (GORD), peptic ulcer, and dyspepsia, represent a major healthcare problem.

AstraZeneca has pioneered research and committed to advancing the treatment of acid related diseases. AstraZeneca's development of the first proton pump inhibitor (PPI) class began in 1974 which ultimately lead to it becoming the world leader in the treatment of acid-related diseases.

Acid reflux

Acid reflux is a condition where gastric juices containing acid travel back from the stomach into the oesophagus (swallowing tube). Some 20% of the population experience this problem on a weekly basis and have a condition called gastro oesophageal reflux disease or GORD.

Symptoms of acid reflux include heartburn (a burning feeling rising from the stomach or lower chest up towards the neck), regurgitation, chest pain, a difficulty in swallowing (dysphagia), hoarseness, dental diseases and asthma.

The food in the stomach is partially digested by stomach acid and enzymes. Normally, the partially digested acidic content in the stomach is delivered by the stomach muscle into the small intestine for further digestion. In patients with acid reflux, stomach acid content refluxes backwards into the oesophagus, causing inflammation and damage.

Factors contributing to acid reflux include fatty foods, cigarettes, chocolate, caffeine, alcohol, obesity, pregnancy and delayed stomach emptying. Obesity and pregnancy increase pressures within the abdomen (body trunk), pushing the stomach contents into the oesophagus. Some patients have stomachs that empty contents into the intestines very slowly. A stomach full of food and acid is more prone to reflux, especially when the patient lies down (supine).

Medications commonly used in the treatment of acid reflux include acid suppressants, such as H2-antagonists and proton-pump inhibitors, which reduce the production of acid in the stomach, and prokinetic agents, which work by increasing the pressure of the lower oesophageal sphincter and promoting emptying of the stomach. Antacids are non-prescription medicines that are commonly used to treat acid-related symptoms, like heartburn or indigestion, and work by neutralising acid in the stomach. However, they are not usually recommended to treat the frequent heartburn suffered by people with GORD.

Ulcers (peptic)

An ulcer is a hole or erosion that forms when the lining of the gut is corroded by acidic digestive juices. Ulcers can form in the lining of the stomach (gastric ulcers), duodenum (the first part of the small intestine) or the oesophagus (swallowing tube).

While stomach acid plays a significant role in the development of ulcers, other factors may be involved, including infection with a bacterium called Helicobacter pylori , smoking, and the long-term use of certain anti-inflammatory medicines.

Symptoms of an ulcer are variable, but may include upper abdominal burning or hunger pain 1-3 hours after meals and in the middle of the night. In some cases, serious complications can occur like bleeding or perforation (erosion of the ulcer right through the gut wall).

Most ulcers are effectively healed with treatment. Treatments for ulcers include:
 

• Antacids which temporarily neutralise existing acid in the stomach 
• Acid suppressants like H2-antagonists and proton-pump inhibitors (in combination with antibiotics if H. pylori infection is involved, which is in more than 90% of cases)

There is no conclusive evidence that dietary restriction and bland diets play a role in ulcer healing. No proven relationship exists between ulcers and the intake of coffee and alcohol. However, as coffee stimulates acid secretion, and alcohol can cause gastritis, moderation in alcohol and coffee consumption is often recommended for patients with ulcers.

Key products

• Nexium (esomeprazole)
• Losec (omeprazole)
• Losec Hp7 (omeprazole, amoxycillin, clarithromycin)
• Entocort (budesomide) AstraZeneca also has an active research programme in this area.