Symptomatic cimetidine treatment of duodenal and prepyloric ulcers

In a randomized trial, 75 patients with an endoscopically confirmed and symptomatic duodenal (N = 50) or prepyloric (N = 25) ulcer were allocated to cimetidine treatment (1 g/day) either regularly for four weeks (standard treatment group) or regularly for a minimum of one week and thereafter only until the symptoms were controlled (symptomatic treatment group). The four-week healing frequencies in the standard and symptomatic treatment groups were 72 and 67%, respectively. The difference +/- 95% confidence limits was 5 +/- 21%. Prospective recording of pain revealed that the two treatment regimens were about equally effective in relieving symptoms during weeks 2-4. Patients with unhealed ulcers reported pain during the day and night significantly more often than those with healed ulcers. In the symptomatic treatment group the average patient saved 11 days of cimetidine medication during weeks 2-4. We believe that disappearance of symptoms might be a valuable means of deciding when treatment for peptic ulcers can be discontinued. Provided its efficacy and safety can be further confirmed, symptomatic treatment might become a practical and possibly a money-saving mode of ulcer management, which should also be applicable to the ulcer regimens of tomorrow.