[Duodenal ulcer, study of gastric secretion and rational treatment with famotidine in different doses]

The authors report their experience with 50 patients affected by duodenal ulcer, 80% of them with a chronic relapsing ulcer. They all underwent endoscopy and study of gastric secretion (BAO and PAO) before beginning therapy with famotidine (40 mg nocturnal) and during this treatment. In 43 patients the secretory values of BAO and PAO resulted above the ulcerogenic limit during the treatment. In 2 cases the secretory values did not decrease under the ulcerogenic limit even during the therapy with 40 mg of famotidine. These 2 cases had been affected by relapsing duodenal ulcer, non responding to H2 antagonists and nocturnal doses of 60 and 80 mg famotidine till the secretory values decreased below the ulcerogenic limit. In such a way we obtained ulcer healing in 4 weeks. The therapy was prolonged for two years with the same dosage at the beginning and later with half doses without any relapse and secondary effects. We emphasize the utility of secretory studies in peptic ulcer and suggest that non-responding duodenal ulcer can depend on very high acid gastric secretion treated by too low doses of H2 antagonists.