[Ulcer healing with ranitidine and antacids despite continued therapy with non-steroidal anti-rheumatic drugs]

The aim of this study was to investigate the course of gastric and duodenal ulcers under ranitidin and antacid treatment during continuous NSAID therapy, and to answer the question of whether ulcers are an absolute contraindication for NSAID treatment. A total of 21 patients (17 females; four males; average age 58 years) with rheumatoid arthritis (18 patients), ankylosing spondylitis (two patients), and cervical spine syndrome (one patient) with gastric and/or duodenal ulcers, demonstrated by endoscopy, entered the study. Because of the severe course of the rheumatic disease present in every patient, there was a need to continue NSAID therapy. Gastric or duodenal ulcers were treated with 300 mg ranitidin and an aluminium-magnesium-hydroxide-containing antacid with an acid binding capacity of 280 mval/day. The course of healing of the ulcers was checked endoscopically and in part by biopsies (gastric ulcers). Within the period of 31 +/- 11 days, all duodenal ulcers under observation had healed. Of the gastric ulcers, 50% had healed completely while the others showed definite improvement. NSAID-induced ulcers were located in or close to the pylorus, contrary to the location of peptic ulcers. These data show that NSAIDs--if administration is absolutely necessary because of the severe course of the rheumatic disease--can be continued even in the presence of gastric or duodenal ulcers when administered with ranitidin and antacids. Because of hemorrhage and perforation in NSAID-induced ulcers, close clinical and endoscopic checks are necessary. Failures, even with the use of H2-blockers, have also been described.