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Refractory peptic ulcers.
T Arakawa1, K Kobayashi, E Z Dajani
1Third Department of Internal Medicine, Osaka City University Medical School, Japan.
Journal of the Association for Academic Minority Physicians : the Official Publication of the Association for Academic Minority Physicians
|January 1, 1992
Summary
Refractory ulcers, those not healing after standard treatment, show improved healing with omeprazole. Higher doses of omeprazole or H2 antagonists may benefit some patients, suggesting varied mechanisms for ulcer healing resistance.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Refractory ulcers are defined as those not healing after 8 weeks of standard antiulcer drug treatment.
- Incidences of refractory duodenal and gastric ulcers are 9% and 20% for H2-receptor antagonists, respectively.
Purpose of the Study:
- To investigate the efficacy of omeprazole in treating refractory ulcers.
- To explore mechanisms underlying refractoriness to H2-receptor antagonists.
Main Methods:
- Comparison of refractory ulcer incidence with standard H2-receptor antagonists versus omeprazole 20 mg daily.
- Analysis of potential mechanisms including acid hypersecretion, preserved daytime acidity, impaired mucosal defense, and Helicobacter pylori infection.
Main Results:
- Omeprazole 20 mg daily reduced refractory duodenal and gastric ulcer incidences to 3% and 11%, respectively.
- Mechanisms for refractoriness include preserved daytime acidity and impaired mucosal defense.
- Omeprazole 40 mg daily appears superior for maintenance therapy in H2 antagonist-refractory ulcers.
Conclusions:
- Omeprazole demonstrates significant efficacy in healing refractory ulcers, likely due to its potent antisecretory action.
- Factors such as impaired mucosal defense and potential Helicobacter pylori infection may contribute to ulcer refractoriness.
- Higher-dose omeprazole (40 mg) shows promise for maintenance therapy in refractory ulcer cases.