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The long-term treatment of peptic ulcer after a bleeding episode
A Capria1, M Geloni, G Federici
1Divisione di Gastroenterologia e Malattie del Ricambio, Ospedale S. Chiara, Pisa, Italy.
Insights
Prolonged ranitidine maintenance treatment appears beneficial for patients with bleeding duodenal ulcers (D.U.). While some experienced side effects, long-term treatment reduced recurrence rates in D.U. patients.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Peptic ulcer bleeding is a significant clinical concern.
- Ranitidine is a common treatment for peptic ulcers.
- Understanding long-term treatment efficacy and recurrence is crucial.
Purpose of the Study:
- To evaluate the efficacy of ranitidine maintenance treatment in patients with bleeding peptic ulcers.
- To assess recurrence rates and side effects associated with long-term ranitidine use.
- To compare outcomes between duodenal ulcer (D.U.) and gastric ulcer (G.U.) patients.
Main Methods:
- Study included 51 patients with bleeding peptic ulcers (30 D.U., 17 G.U., 3 anastomotic, 1 esophageal).
- Initial treatment with ranitidine for 6-8 weeks led to healing in 46/48 patients.
- Patients were then randomized to continue or stop ranitidine maintenance (150 mg/night) for 6 months, with follow-up up to 2 years.
Main Results:
- Ranitidine healed 46 of 48 ulcers initially.
- After 6 months maintenance, 2 G.U. patients had gastritis, and 2 D.U. patients had recurrences.
- Stopping treatment led to recurrence with hemorrhage in 5/15 D.U. patients, while 8/8 continued treatment had no recurrence.
- Long-term ranitidine use showed a trend favoring prolonged treatment in bleeding D.U. patients.
Conclusions:
- Prolonged ranitidine maintenance treatment may reduce recurrence in bleeding duodenal ulcer patients.
- While some side effects like gastritis occurred, they were infrequent.
- Further studies with larger cohorts are needed to confirm these findings.
Abstract:
We have studied 51 consecutive patients bleeding from peptic ulcer which was duodenal (D.U.) in 30, gastric in 17 (G.U.), anastomotic in 3 (Billroth 2), and oesophageal in 1 of them. One patient with G.U. was sent for surgery and 2 patients with D.U. died early; the others recovered through medical treatment and the ulcer healed after 6-8 weeks of treatment with ranitidine in 46 out of 48 patients. Subsequently, all the healed patients have been treated with ranitidine (150 mg at bedtime) for 6 months; by this time a new endoscopy showed an erosive antral gastritis in 2 patients with G.U. and 2 recurrences of D.U. Then the patients and their family doctors were invited to choose between the interruption of the treatment and its prolongation. 8 patients with previous G.U. preferred to stop treatment, and up to 1-2 years they did not show any recurrence; the remaining 5 patients carried on the maintenance treatment, and up to one year one of them showed an erosive antral gastritis. 15 patients with previous D.U. stopped the treatment and 5 of them after 1-24 months presented a recurrence with a new haemorrhage; 8 patients chose to continue the treatment and none of them for 6-24 months had recurrence. The limited number of the patients obviously does not allow a sound conclusion, but a trend is clearly seen which favours a prolonged maintenance treatment in patients with D.U. which has bled.