Gastrointestinal Disorders: New Therapies For The New Millennium

Therapeutic

The market for gastrointestinal (GI) disorder therapies is undergoing pivotal changes.

With this in mind, Scrip Reports brings you Gastrointestinal Disorders � New therapies for the new millennium, containing the very latest market information for GI treatments and providing a timely overview of major future trends.

Disease facts, treatment options, world market data, forecasts to 2002 and active research areas are supplied for each disorder in a clear, in-depth style. In addition, the report describes strengths and weaknesses of the key GI products and provides extensive information on drugs in R&D for each major GI disorder.

Gastrointestinal Disorders � New therapies for the new millennium covers individual therapeutic categories, with a particular focus on the major GI disorders, including gastroesophageal reflux disease (GERD); peptic ulcers; inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

Also included in this report are detailed profiles of the top 17 players in the GI market.

PUBLISHED: October 2000
REF: BS1073E
PAGES: 180+
PRICE: £595/$1250/¥143,000

CONTENTS
LIST OF TABLES
LIST OF FIGURES
EXECUTIVE SUMMARY
ABBREVIATIONS AND GLOSSARY


CHAPTER 1 INTRODUCTION TO GASTROINTESTINAL DISORDERS
1.1 Definition of gastrointestinal disorders
1.2 Diagnosis of GI disorders
1.2.1 Diagnostic criteria
1.2.2 Radiographic techniques
1.2.2.1 Barium meal
1.2.2.2 Barium enema
1.2.3 Endoscopic techniques
1.2.3.1 Oesophagoscopy
1.2.3.2 Gastroscopy
1.2.3.3 Upper GI endoscopy
1.2.3.4 Proctoscopy
1.2.3.5 Sigmoidoscopy
1.2.3.6 Colonoscopy
1.2.4 Other techniques
1.3 Types of GI disorders
1.3.1 Gastroesophageal reflux disease
1.3.2 Gastritis and GI ulcers
1.3.2.1 Gastritis
1.3.2.2 GI ulcers
1.3.2.3 Association between H. pylori and gastritis/peptic ulcers
1.3.2.4 Association between non-steroidal anti-inflammatory drugs and gastritis/peptic ulcers
1.3.3 Inflammatory bowel diseases
1.3.3.1 Crohn's disease
1.3.3.2 Ulcerative colitis
1.3.4 Functional GI disorders
1.3.4.1 Irritable bowel syndrome
1.3.4.2 Functional (non-ulcer) dyspepsia
1.3.4.3 Functional constipation
1.4 Incidence and prevalence of GI disorders
1.4.1 Incidence and prevalence of gastroesophageal reflux disease
1.4.2 Incidence and prevalence of gastritis and GI ulcers
1.4.3 Incidence and prevalence of inflammatory bowel diseases
1.4.4 Incidence and prevalence of irritable bowel syndrome
1.5 The economic cost of GI disorders
1.5.1 Economic cost of gastroesophageal reflux disease
1.5.2 Economic cost of gastritis and GI ulcers
1.5.3 Economic cost of inflammatory bowel diseases
1.5.4 Economic cost of irritable bowel syndrome
1.6 The management of GI disorders
1.6.1 Gastroesophageal reflux disease management
1.6.1.1 Non-pharmacological treatment of gastroesophageal reflux disease
1.6.1.2 Pharmacological treatment of gastroesophageal reflux disease
1.6.2 Gastritis and peptic ulcer management
1.6.2.1 Non-pharmacological treatment of gastritis and peptic ulcers
1.6.2.2 Pharmacological treatment of gastritis and peptic ulcers
1.6.3 Inflammatory bowel disease management
1.6.3.1 Non-pharmacological treatment of inflammatory bowel diseases
1.6.3.2 Pharmacological treatment of inflammatory bowel diseases
1.6.4 Irritable bowel syndrome management
1.6.4.1 Non-pharmacological treatment of irritable bowel syndrome
1.6.4.2 Pharmacological treatment of irritable bowel syndrome
1.7 Conclusion

CHAPTER 2 GASTROINTESTINAL DRUGS ON THE MARKET
2.1 Introduction
2.2 Marketed drugs for acid GI disorders
2.2.1 Acid-suppressing agents
2.2.1.1 Histamine H2 antagonists
2.2.1.2 Proton pump inhibitors
2.2.2 Acid neutralising agents and cytoprotectants
2.2.2.1 Antacids
2.2.2.2 Cytoprotectants
2.2.3 Prokinetic agents
2.2.4 H. pylori eradication therapies
2.3 Marketed drugs for inflammatory bowel diseases
2.3.1 Aminosalicylates
2.3.2 Corticosteroids
2.3.3 Immunomodulators
2.4 Marketed drugs for irritable bowel syndrome
2.4.1 Antispasmodics
2.4.2 Antidiarrhoeals
2.4.3 Alosetron
2.5 Conclusion

CHAPTER 3 GASTROINTESTINAL DRUGS IN DEVELOPMENT
3.1 Introduction
3.2 Drugs in development for acid GI disorders
3.2.1 Acid-suppressing agents
3.2.1.1 Antigastrin-17
3.2.1.2 BY-112
3.2.1.3 CR-2945
3.2.1.4 Esomeprazole
3.2.1.5 H-335/25
3.2.1.6 IY-81149
3.2.1.7 Osutidine
3.2.1.8 Pibutidine
3.2.1.9 Tenatoprazole
3.2.1.10 YH-1885
3.2.2 Acid neutralising agents and cytoprotectants
3.2.2.1 DA-9601
3.2.2.2 Dosmalfate
3.2.2.3 Egualen sodium
3.2.2.4 NE-0080
3.2.3 Prokinetic agents
3.2.3.1 GM-611
3.2.3.2 JK-1085
3.2.3.3 Z-338
3.2.4 H. pylori eradication therapies
3.2.4.1 Helicide
3.2.4.2 H. pylori vaccine - Antex
3.2.4.3 H. pylori vaccine - Peptide Therapeutics
3.3 Drugs in development for inflammatory bowel disease
3.3.1 Biologic agents
3.3.1.1 BXT-51072
3.3.1.2 CDP-571
3.3.1.3 ICM3
3.3.1.4 Interleukin-10
3.3.1.5 LDP-02
3.3.1.6 Natalizumab
3.3.1.7 Thalidomide - Andrulis
3.3.1.8 Thalidomide - Celgene
3.3.2 Miscellaneous mechanisms of action
3.3.2.1 APC-2059
3.3.2.2 ATL-2502
3.3.2.3 OP-2000
3.3.2.4 Ridogrel
3.3.2.5 Tazofelone
3.4 Drugs in development for irritable bowel syndrome
3.4.1 Serotonergic modulators
3.4.1.1 CHF-17454
3.4.1.2 Cilansetron
3.4.1.3 E-3620
3.4.1.4 LY-315535
3.4.1.5 MKC-733
3.4.1.6 Norcisapride
3.4.1.7 Piboserod
3.4.1.8 Prucalopride
3.4.1.9 Renzapride
3.4.1.10 Tegaserod
3.4.2 Other mechanisms of action
3.4.2.1 Calcium polycarbophil
3.4.2.2 Dexloxiglumide
3.4.2.3 Fedotozine
3.4.2.4 SR-58611
3.5 Conclusion


CHAPTER 4 GASTROINTESTINAL DRUGS MARKET INFORMATION
4.1 Introduction
4.2 Market value
4.2.1 World pharmaceutical sales
4.2.2 The gastointestinal market
4.3 Market structure
4.3.1 The market for acid disorder drugs
4.3.1.1 Acid suppressants
4.3.2 The market for inflammatory bowel disease drugs
4.3.3 The market for irritable bowel syndrome drugs
4.4 Market growth
4.4.1 Market growth for acid disorder drugs
4.4.1.1 Market growth for acid suppressants
4.4.2 Market growth for inflammatory bowel disease drugs
4.4.3 Market growth for functional GI disorder drugs
4.5 Market influences

CHAPTER 5 SELECTED COMPANY PROFILES
5.1 Abbott
5.1.1 Financial highlights
5.1.2 GI portfolio/pipeline
5.2 Alizyme plc
5.2.1 Agreements regarding GI therapies
5.2.2 Financial highlights
5.2.3 Gastrointestinal portfolio/pipeline
5.3 American Home Products Corporation
5.3.1 Agreements regarding GI therapies
5.3.2 Financial highlights
5.3.3 Gastrointestinal portfolio/pipeline
5.4 AstraZeneca
5.4.1 Agreements regarding GI therapies
5.4.2 Financial highlights
5.4.3 GI portfolio/pipeline
5.5 Altana/Byk Gulden
5.5.1 Agreements regarding GI therapies
5.5.2 Financial highlights
5.5.3 GI portfolio/pipeline
5.6 Axcan Pharma Inc
5.6.1 Agreements regarding GI therapies
5.6.2 Financial highlights
5.6.3 GI portfolio/pipeline
5.7 Axys Pharmaceutical Inc
5.7.1 Agreements regarding GI therapies
5.7.2 Financial highlights
5.7.3 GI portfolio/pipeline
5.8 Celltech Group plc
5.8.1 Financial highlights
5.8.2 GI portfolio/pipeline
5.9 Chugai Pharmaceutical Co Ltd
5.9.1 Agreements regarding GI therapies
5.9.2 Financial highlights
5.9.3 GI portfolio/pipeline
5.10 Eisai Co Ltd
5.10.1 Agreements regarding gastrointestinal therapies
5.10.2 Financial highlights
5.10.3 Gastrointestinal portfolio/pipeline
5.11 Glaxo Wellcome
5.11.1 Agreements regarding gastrointestinal therapies
5.11.2 Financial highlights
5.11.3 Gastrointestinal portfolio/pipeline
5.12 Eli Lilly
5.12.1 Agreements regarding GI therapies
5.12.2 Financial highlights
5.12.3 GI portfolio/pipeline
5.13 Neose Technologies Inc
5.13.1 Agreements regarding GI therapies
5.13.2 Financial highlights
5.13.3 GI portfolio/pipeline
5.14 Novartis Pharma AG
5.14.1 Financial highlights
5.14.2 GI portfolio/pipeline
5.15 SmithKline Beecham
5.15.1 Agreements regarding gastrointestinal therapies
5.15.2 Financial highlights
5.15.3 Gastrointestinal portfolio/pipeline
5.16 Solvay SA
5.16.1 Agreements regarding GI therapies
5.16.2 Financial highlights
5.16.3 GI portfolio/pipeline
5.17 Takeda
5.17.1 Agreements regarding GI therapies
5.17.2 Financial highlights
5.17.3 GI portfolio/pipeline
CHAPTER 6 DIRECTORY
REFERENCES


LIST OF TABLES
Table 1.1 The manifestations of gastroesophageal reflux disease
Table 1.2 Classifications of gastritis
Table 1.3 Symptoms associated with peptic ulcers
Table 1.4 Symptoms of Crohn's disease
Table 1.5 Symptoms of ulcerative colitis
Table 1.6 Sub-classifications of ulcerative colitis
Table 1.7 Symptoms associated with irritable bowel syndrome
Table 1.8 Manning criteria for the diagnosis of irritable bowel syndrome
Table 1.9 Rome I and Rome II criteria for the diagnosis of IBS
Table 1.10 Rome criteria for the diagnosis of functional dyspepsia
Table 1.11 Rome criteria for the diagnosis of functional constipation
Table 1.12 Gastointestinal associated mortality rates for selected countries
Table 1.13 Average length of hospital stay due to GI disorders in selected countries
Table 1.14 Average length of hospital stay due to peptic ulcer disease in selected countries
Table 1.15 Selected current gastroesophageal reflux disease therapies on the market
Table 1.16 Examples of current antigastritis/ulcer therapies on the market
Table 1.16 Examples of current anti-H. pylori therapies on the market
Table 1.18 Drugs used in inflammatory bowel disease by pharmacology
Table 1.19 Examples of current inflammatory bowel disease therapies on the market
Table 1.20 Examples of current irritable bowel syndrome therapies on the market

Table 2.1 Marketed histamine H2 antagonists
Table 2.2 Comparison of GI acid disorder drugs
Table 2.3 Marketed proton pump inhibitors
Table 2.4 Examples of prescription antacids and cytoprotectants
Table 2.5 Marketed prokinetic drugs
Table 2.6 Current anti-H. pylori therapies on the market
Table 2.7 Marketed aminosalicylates used in inflammatory bowel disease
Table 2.8 Characteristics and formulations for selected mesalazine preparations
Table 2.9 Marketed corticosteroids used in inflammatory bowel disease
Table 2.10 Selected marketed drugs used in irritable bowel syndrome therapy

Table 3.1 Acid-suppressing drugs in development
Table 3.2 Cytoprotectants in development
Table 3.3 Prokinetic agents in development
Table 3.4 H. pylori eradication therapies in development
Table 3.5 Biologic inflammatory bowel disease therapies in development
Table 3.6 Non-biologic inflammatory bowel disease therapies in development
Table 3.7 Serotonergic modulators in development for irritable bowel syndrome
Table 3.8 Non-serotonergic agents in development for irritable bowel syndrome

Table 4.1 World pharmaceutical sales, 1999
Table 4.2 Top 10 major therapeutic categories
Table 4.3 Leading GI companies by acid disorder agents, 1999
Table 4.4 Estimated worldwide sales of selected branded histamine H2 antagonists, 1999
Table 4.5 Estimated worldwide sales of proton pump inhibitors, 1999

Table 5.1 Abbott's financial results, 1998-2000 (1st quarter)
Table 5.2 Abbott's sales by region, 1998-1999
Table 5.3 Abbott's healthcare sales by business area, 1998-1999
Table 5.4 Alizyme's financial results, 1998-2000
Table 5.5 American Home Products' financial results, 1998-2000 (1st quarter)
Table 5.6 American Home Products' sales by region, 1998-1999
Table 5.7 American Home Products' healthcare sales by business segment, 1998-2000
Table 5.8 AstraZeneca's financial results, 1998-2000 (1st quarter)
Table 5.9 AstraZeneca's sales by region, 1998-2000 (1st quarter)
Table 5.10 AstraZeneca's healthcare sales by therapeutic area, 1998-1999
Table 5.11 AstraZeneca's sales by major pharmaceutical product, 1998-1999
Table 5.12 Altana's financial results, 1998-2000 (1st quarter)
Table 5.13 Altana's sales by region, 1998-2000 (1st quarter)
Table 5.14 Altana's healthcare sales by therapeutic area, 1998-1999
Table 5.15 Altana's sales by major pharmaceutical product, 1999
Table 5.16 Axcan's financial results, 1997-1999
Table 5.17 Axys' financial results 1998-2000
Table 5.18 Celltech's proforma financial results, 1998-1999
Table 5.19 Chugai's financial results, 1998-2000
Table 5.20 Chugai's sales by region, 1998-2000
Table 5.21 Eisai's financial results, 1998-2000
Table 5.22 Eisai's leading domestic pharmaceutical products, 1999-2000
Table 5.23 Glaxo Wellcome's financial results, 1998-2000 (1st quarter)
Table 5.24 Glaxo Wellcome's sales by region, 1998-1999
Table 5.25 Glaxo Wellcome's healthcare sales by therapeutic area, 1998-1999
Table 5.26 Glaxo Wellcome's sales by major pharmaceutical product, 1998-1999
Table 5.27 Eli Lilly's financial results, 1998-2000 (1st quarter)
Table 5.28 Eli Lilly's leading product sales, 1998-1999
Table 5.29 Neose's financial results, 1998-2000
Table 5.30 Novartis' financial results, 1998-2000 (1st quarter)
Table 5.31 Novartis' group sales by major regions, 1998-1999
Table 5.32 Novartis' sales by therapeutic area, 1998-2000 (1st quarter)
Table 5.33 Novartis' sales by major pharmaceutical product, 1999
Table 5.34 SmithKline Beecham's financial results, 1998-2000 (1st quarter)
Table 5.35 SmithKline Beecham's sales by business section, 1998-1999
Table 5.36 SmithKline Beecham's sales by therapeutic sector, 1998-1999
Table 5.37 Solvay's financial results, 1998-1999
Table 5.38 Solvay's top six leading products, 1999
Table 5.39 Takeda's financial results, 1998-2000
Table 5.40 Takeda's sales by region, 1999-2000


LIST OF FIGURES
Figure 1.1 A schematic of the GI tract
Figure 1.2 Prevalence of upper GI symptoms in selected developed nations
Figure 1.3 Prevalence of upper GI symptoms by age
Figure 1.4 Incidence of heartburn in the US per 1,000 population, 1996
Figure 1.5 Incidence of peptic ulcers in the US per 1,000 population, 1996
Figure 1.6 Incidence of irritable bowel syndrome in the US per 1,000 population, 1996

Figure 2.1 The sites of action of certain acid disorder drugs

Figure 3.1 Percentage of erosive oesophagitis patients healed with esomeprazole or omeprazole
Figure 3.2 Percentage of patients with intragastric pH above 4

Figure 4.1 Pharmaceutical sales for 12 key markets in for the 12 months to December 1999
Figure 4.2 Leading companies in the gastrointestinal market
Figure 4.3 Gastrointestinal acid disorder products market by category
Figure 4.4 Market share of acid suppressants by category
Figure 4.5 Market share of proton pump inhibitors, 1999
Figure 4.6 Acid suppressant market by geographical region, 1999
Figure 4.7 Proton pump inhibitor and H2 antagonists markets by geographical region, 1999
Figure 4.8 Market trends for the GI products market, projected to 2002
Figure 4.9 Market trends for the GI acid disorder products market, projected to 2002
Figure 4.10 Market trends for cytoprotectants and acid neutralising products, projected to 2002
Figure 4.11 Market trends for the H2 antagonist, projected to 2002
Figure 4.12 Market trends for the proton pump inhibitor sales, projected to 2002
Figure 4.13 Market trends for inflammatory bowel disease therapies, projected to 2002
Figure 4.14 Market trends for anti-TNF-alpha agents, projected to 2002
Figure 4.15 Market trends for functional GI disorder drugs, projected to 2002
Figure 4.16 Market trends for irritable bowel syndrome drugs, projected to 2002
Figure 4.17 Market trends for serotoninergic modulators, projected to 2002


EXECUTIVE SUMMARY
'This is an exciting time in gastroenterology when so many opportunities for new diagnostic tests and treatments are opening up.'
Sir Leslie Turnberg, President of the British Society of Gastroenterology, March 2000.

Gastrointestinal (GI) disorders are the most common ailments in the industrialised world and nearly everyone will be affected by a GI disorder during the course of his or her lifetime. GI disorders are a group of conditions that affect the digestive system. These can range from something as innocuous as a mild stomach upset to serious conditions, such as peptic ulcer disease or Crohn's disease.


In the industrialised world, GI disorders can affect up to 40% of the population and in the US alone, more than 95 million people are believed to experience some form of GI disorder, with over 10 million people hospitalised each year due to GI complications. Epidemiological data for the developing world is less well documented but evidence suggests that non-infectious disease-related GI disorders are becoming more prevalent.


GI disorders encompasses a wide spectrum of complex diseases and symptoms. These include the occasional discomfort of heartburn to debilitating inflammatory conditions such as Crohn's disease and ulcerative colitis. This report will focus on the most important disease categories within GI disorders. This will include discussions on the management of gastroesophageal reflux disease (GERD), gastritis and peptic ulcer disease, inflammatory bowel diseases (IBD) and functional GI disorders such as irritable bowel syndrome (IBS).


The GI market is expected to undergo a state of flux as the world's best-selling product, AstraZeneca's antiulcerant, omeprazole (Losec), comes off patent around the world in 2001-2004. Losec accounts for approximately 30% of the global antiulcerant market. The loss of patent of such a high profile product will impact the whole market for prescription GI drugs.

Chapter 1 introduces the major GI disorders with in-depth coverage of the definitions, pathogenesis and the therapeutic options available for GI acid disorders (GERD, gastritis and peptic ulcer disease), IBD (Crohn's disease and ulcerative colitis) and functional GI disorders (functional dyspepsia and IBS). GERD is the most common of the serious GI disorders. Current estimates suggest that 21-40% of people suffer symptoms of GERD and in the US 35-40% of the adult population suffer heartburn at least once a month. Peptic ulcer disease has a prevalence of 5-10% in developed countries and is still one of the leading causes of hospitalisation. The American College of Gastroenterology estimates that 20-25 million people in the US currently suffers from peptic ulcer disease or will develop an ulcer in their lifetime. The extent of these acid disorders places an enormous burden on both national health systems and the individuals who suffer. Out-of-pocket expenses for people with GI disorders are normally higher when compared with patients with other chronic problems such as diabetes, due to the greater use of self-medication by people affected by GI disorders.


Functional GI disorders are also extremely common and can affect 23-41% of the population in developed nations. Up to 20% of the adult population in developed countries is estimated to be affected by IBS, one of the main functional disorders, and in the US, 1 in 5 of the population are thought to suffer from the condition. Moreover, between 60-70% of IBS sufferers are female. Whilst IBS is not life-threatening, its causes immense suffering and discomfort to those affected by the condition and it is one of the leading causes of work absenteeism. IBD is currently one of the least common GI disorders but it is increasing in incidence. The two forms of IBD, Crohn's disease and ulcerative colitis, have similar characteristics of relapse and remission. The chronic and incurable nature of IBD makes the disease an important consideration in the spectrum of GI disorders.


Many of the drugs used to treat GI disorders are mature products. However, a number of new agents have recently been introduced that have exciting market potential.

Chapter 2 will review the current marketed prescription drugs in the GI sector, with an emphasis on strengths and weaknesses of agents with strong market presence and new introductions to the GI market. Self-medication also plays an important role in the market for GI therapies, particularly agents used in the treatment of acid disorders. Prescription drugs have to compete with the numerous products available over-the-counter, which are also aimed at relieving the symptoms of the major GI disorders. However, whilst this crowded market is extremely competitive, the sheer number of potential consumers makes this therapy group highly lucrative. Increased patient awareness has also increased the number of patients seeking medical advice with a subsequent rise in the use of prescription-only-medicines.


The acid disorders segment is by far the largest in the GI category and acid suppression drugs, such as the histamine H2 antagonists and proton pump inhibitors, are the mainstay of gastric acid-related GI disorders In particular, the proton pump inhibitors represent a multi-billion dollar market. The PPIs have shown tremendous growth year on year for the past 9 years but their position is under threat with the impending loss of patent protection for the category's most successful agent, AstraZeneca's omeprazole (Losec/Prilosec). The more mature H2 antagonists have struggled to compete with the proton pump inhibitors and there has been a move towards the OTC market for some of the more mature products.


Many of the agents used to alleviate the symptoms of functional GI disorders are also available as OTC-products, especially laxative and antidiarrhoeals drugs. However, the current therapy for IBS, which has multiple symptoms, is rather limited. Glaxo Wellcome's new serotoninergic modulator, alosetron (Lotronex), represents a new force in the treatment of IBS. The product has the potential to control many of the symptoms of diarrhoea-predominant IBS and is predicted to be a success in this field.


The agents used to treat IBD are established drugs, with indications for various other inflammatory or infective disorders. However, the introduction of Centocor's antitumour necrosis factor-alpha monoclonal antibody, infliximab (Remicade), has caused excitement within the medical profession. Remicade's novel mechanism of action is predicted to advance the treatment of Crohn's disease.


The industry has benefited from major scientific advances the GI disorders field, which has helped provide a greater understanding of the various GI disorders. The pathogenesis of GERD, peptic ulcer diseases, IBD and IBS is now better understood and this has helped to select new targets for disease treatment. In addition, the GI sector has embraced the new biotechnologies as important tools in the development of innovative new drugs.

Chapter 3 provides a thorough review of all the latest developments in the GI therapeutic category. The important drug candidates will be previewed and their market potential assessed. In the IBS and IBD therapeutic categories, the launch of innovative novel treatments has led the shift away from the 1traditional targets. The current R&D focus has now moved towards the concept of the 'brain-gut' axis as a target for treating IBS and in particular the involvement of the serotonin (5-HT) neurotransmitter pathway. Similarly, the search for more effective IBD drugs has led to the development of biologic agents. The term 'biologic agent' is often used to describe molecules that have been designed to target specific sites or components in the immune response cascade. Biologic agents have been a major innovation in the treatment of IBD. Novel biologic agents in development include recombinant cytokines, recombinant anti-adhesion molecules, antisense agents and humanised monoclonal antibodies. New target sites include antitumour necrosis factor alpha (TNF-alpha), intercellular adhesion molecule (ICAM), and the transcription factors, nuclear factor kappa-B and the alpha-4 beta-7 protein.
In the acid disorder category, the most important agent in development is AstraZeneca's new PPI, esomeprazole (Nexium). There are a lot of expectations for Nexium and its potential will be fully assessed.


Such is the extent of this group of conditions that the market value for the GI therapeutic sector has been consistently one of the largest, second only to sales of cardiovascular products.

Chapter 4 provides a valuable insight into the present and future status of this lucrative market, which is currently valued at $26-28 billion worldwide.
Finally, the major players and companies with potential in the GI sector will be profiled in

Chapter 5. The profiles will include a review of each companies core products and GI portfolio/pipelines.

1 Note: Definition of GERD: reflux of gastric contents into the oesophagus. Erosive oesophagatis is a distinct condition/symptom due to GERD.


© PJB Publications Ltd. 2000
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