Short-term treatment of gastric ulcer

Gastric ulcer is relatively infrequent, and clinical trials are often based on small-sized samples. The aim of this study was to define the gold standard therapy of active gastric ulcer. We included all single- or double-blind clinical trials on the short-term treatment of gastric ulcer. All the articles published over the period 1977–1994 were reviewed. Meta-analysis was done with both fixed and random effect models; results were shown using Galbraith's radial plot. Forty-eight papers comprising 52 studies were evaluated. Cimetidine, ranitidine, and famotidine proved significantly better than placebo [odds ratio (OR) and 95% confidence interval (CI 95%) at four to six weeks were: 2.67 (2.03–3.52), 3.94 (2.28–6.80), 1.76 (1.08–2.88), respectively]. Cimetidine and ranitidine had results comparable with the newer H₂ blockers [OR (CI 95%) at four weeks: 1.16 (0.91–1.47), 1.11 (0.80–1.55), respectively]. H₂ blockers were proved comparable with either sucralfate [OR (CI 95%) at eight weeks: 0.81 (0.37–1.79)] or bismuth [OR (CI 95%) at four to six weeks: 0.67 (0.37–1.20)]. Omeprazole is more effective than H₂ blockers [OR (CI 95%) at four weeks: 2.00 (1.57–2.55)]. It is concluded that H₂ blockers are preferred to either a placebo or sucralfate for short-term gastric ulcer treatment; the newer H₂ blockers do not have significant advantages over the older types; omeprazole can be regarded as the gold standard for active gastric ulcer treatment.The statistical analysis and computing with plot program was performed by G. Leandro, MD, Biostatistician. This work was performed under the auspices of the Roberto Farini Foundation for Gastroenterological Research.     

Efficient treatment of gastric ulcer with proglumide (Milid) in outpatients (double blind trial).

Eleven male and five female gastric ulcer outpatients as well as twenty eight male and seven female duodenal ulcer outpatients received Proglumide (1200 mg/day) or magnesiumtrisilicate (1320 mg/day) in a prospective double blind study. The sizes of the ulcers were assessed by endoscopy before and after 4 weeks therapy. A complete healing of gastric ulcers was observed in 75% (n = 8) of the patients receiving Proglumide and 25% (n = 8) of the antacid treated controls (p less than 0.05; x2 test). The healed area was significantly (p less than 0.05) larger in the Proglumide 91 mm2) than in the anticida group (23 mm2). In addition, the half time of the ulcer-healing was significantly (p less than 0.05) shorter in the Proglumide treated patients (18 days and 26 days respectively). There was no significant effect of the drug on the duodenal ulcers. The spontaneous healing rate was 61% in the antacid (n = 18) and 59% in the Proglumide treated (n = 17) patients. The drug does not effect the basal and pentagastrin stimulated gastric secretion nor the serum gastrin concentration. No side effects on blood pressure, blood cell count, transaminases or blood glucose concentrations could be observed.     

常规三联疗法联合丹参注射液治疗胃溃疡的临床效果及安全性观察

目的观察常规三联疗法联合丹参注射液应用于胃溃疡治疗的临床疗效和安全性。方法随机将住院治疗的140例胃溃疡患者分为观察组70例和对照组70例。对照组采取常规三联疗法治疗,观察组采用常规三联疗法联合丹参注射液治疗,均连续治疗一个月。观察并比较两组患者的临床症状改善情况、溃疡的愈合程度以及幽门螺杆菌(HP)清除情况及不良反应发生情况。结果观察组显效44例,有效22例,无效4例;对照组显效33例,有效20例,无效17例。观察组临床疗效优于对照组(P 0. 05)。观察组的药物不良反应发生率为2. 86%,低于对照组的11. 43%(P 0. 05)。结论使用常规三联疗法联合丹参注射液治疗胃溃疡可以取得很好的临床疗效,安全性也可以得到保障。     

Trimipramine in the treatment of gastric ulcer.

Forty patients with endoscopically confirmed gastric ulcers, completed a double-blind study comparing trimipramine with placebo during 4 weeks' treatment. The daily dose of trimipramine was 50 mg given before bedtime. No serious side-effects occurred. After four weeks' treatment 12 of the 20 patients receiving trimipramine had endoscopically completely healed ulcers, while in the placebo group only 4 of the 20 ulcers were healed (P = 0.025). With regard to the patients' complaints, a distinct and statistically significant improvement was also observed in the patients receiving trimipramine (P = 0.025). It is assumed that the previously shown antisecretory effect of the drug, together with the sedative and anti-depressive effect, make trimipramine a valuable drug in the treatment of peptic ulcer disease.