Antacids in the treatment of duodenal ulcer

Fifty patients with endoscopically proven pyloric-prepyloric ulcers (PU/PPU) and 50 with duodenal ulcers (DU) completed a six-week double-blind clinical trial initially comprising 124 patients. The antacid-treated patients received 10 ml of an antacid suspension seven times a day (buffering 367.5 mmol acid). Healing rate after three weeks of treatment was 74% in the antacid and 42% in the placebo group (p less than 0.01). After six weeks the corresponding figures were 96 and 68% (p less than 0.001). Regarding the PU/PPU and DU subgroups we found significant differences compared to placebo in the PU/PPU group only. Antacids caused a significantly faster and more perceptible pain relief than placebo. We found no significant correlation between ulcer healing and smoking habits. Regression analyses showed that, besides antacids, ulcer size and peak acid output influenced the healing rate significantly.     

Medical treatment of gastric and duodenal ulcer

Summary Antacids prove ready if only temporary relief of the symptoms of ulcers. Physicians have been able to increase the rate of healing of gastric ulcers by advising patients to stop smoking and then either admit them to hospital for bed-rest, or use carbenoxolone sodium as an outpatient therapy. The early trials of some other drugs have shown increase in rate of healing of gastric ulcer, but there is no medical treatment which will prevent the high recurrence rate of benign gastric ulcer. The limited data indicate that adequate medical reduction in acid secretion and enhancement of mucosal resistance may benefit patients with duodenal ulcer.Presented at the meeting on Gastric and duodenal ulcer disease: Basic principles and clinics of treatment by drugs and operations, Marburg, November 22, 1975     

Long-term ranitidine treatment for the maintenance of duodenal ulcer healing

The purpose of the present trial was to verify the efficacy and safety of long-term ranitidine treatment (150 mg at bedtime for 1 year) for the maintenance of duodenal ulcer healing in 22 patients following a successful short-term course of therapy with ranitidine at the full dose of 300 mg per day. Of the 16 patients who completed the trial - there were 6 drop-outs - 4 suffered relapses during the year of treatment (25% cumulative recurrence rate), while remission persisted in the remaining 12 patients (75%). Biochemical tests revealed no statistically significant differences in mean fasting serum pepsinogen and trypsinogen as compared to mean basal values. Mean fasting serum gastrin showed a statistically significant rise from 156 +/- 27 S.D. to 258 +/- 110 S.D. pg/ml (p less than 0.01) only at the 12th month of therapy and rapidly returned to normal (162 +/- 34 S.D.) as soon as therapy was discontinued. No side-effects of any consequence were observed.     

Roxatidine in duodenal ulcer

Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26); roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p < 0.05). No adverse event was reported during 4 weeks of treatment with roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.