Further Experience With Anticholinergic Drugs:

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THE formation of a peptic ulcer is associated with the action of acid peptic juice. When free hydrochloric acid is absent, its formation is impossible. Conversely, increased free acid secretion is commonly present in patients with duodenal ulcer. Although the ancient Greeks and Romans used alkalies for the treatment of “acid stomach,” Sippy1 was the first to introduce an intensive program of neutralizing the gastric acidity in patients with peptic ulcer. His treatment resulted in a high percentage of healing. Various modifications of Sippy's original treatment using different neutralizing agents and a more liberal diet have appeared, but the basis for the treatment of peptic ulcer — adequate neutralization of gastric acidity — has remained the same.

The physiologic basis for the operations of vagotomy and gastroenterostomy for duodenal ulcer is the fact that patients with these ulcers have increased acidity and secretion2,3 due to vagal stimulation which can be abolished by section of the vagal nerves to the stomach.4,5 Since cutting the vagus nerves decreases acidity and secretion, the possibility of medically blocking the vagal impulses as treatment for duodenal ulcer arose. The Sippy program is one of neutralizing the excess acid secreted. The objective of anticholinergic drugs is to suppress and prevent the excess acid secretion.

Tetraethyl ammonium chloride is capable of decreasing gastric secretion and motility and is an effective drug for this purpose. However, it must be given intravenously, the action is relatively brief, and it causes extreme hypotension. The hexamethonium salts are blocking agents, but again have . . .



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