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[H2-blocker refractory ulcers: what can be done?].

H G Dammann1

  • 1Krankenhaus Bethanien, Hamburg, Bundesrepublik Deutschland.

Zeitschrift Fur Gastroenterologie
|April 1, 1992
PubMed
Summary

H2-receptor antagonist refractory ulcers are rare. Omeprazole, particularly at higher doses, shows promise in treating these ulcers when standard therapies fail, offering an alternative to surgery.

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Area of Science:

  • Gastroenterology
  • Pharmacology

Context:

  • H2-receptor antagonist (H2RA) refractory ulcers represent a small but challenging subset of peptic ulcer disease.
  • Defining refractoriness requires a minimum of 2-3 months of consistent H2RA therapy at standard or high doses.

Purpose:

  • To evaluate the efficacy of alternative treatments for H2RA-refractory duodenal ulcers.
  • To assess omeprazole as a potential therapeutic option for ulcers resistant to H2RAs.

Summary:

  • While initial trials showed no significant difference between omeprazole 20 mg/day and ranitidine 300 mg/day, further studies indicated superior healing rates with omeprazole at 40 mg/day compared to ranitidine 300 mg/day or cimetidine 800 mg/day.
  • High-dose omeprazole (40-60 mg/day) demonstrates convincing clinical results for H2RA-resistant ulcers, which are prone to rapid relapse.
  • Surgical intervention remains an option for refractory cases unresponsive to medical management.

Impact:

  • Provides evidence supporting the use of higher-dose omeprazole for difficult-to-treat peptic ulcers.
  • Offers clinicians alternative treatment strategies beyond standard H2RA therapy for refractory ulcer cases.
  • Highlights the potential for omeprazole to improve healing rates and reduce relapse in H2RA-resistant ulcers.

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