Cimetidine versus surgery for recurrent ulcer after gastric surgery

The efficacy of cimetidine vs. surgery in the treatment of recurrent ulcers after definitive surgery for chronic duodenal ulcer was evaluated in two comparable groups (23 each) of patients. Cimetidine 1 g daily healed 79% and 91.6% of recurrent ulcers, as assessed endoscopically, after 6 and 12 weeks respectively. At the end of one year, maintenance treatment with cimetidine (400 mg nocte) prevented relapse in 89.5% of the healed ulcers, while surgery was successful in 94.4% (p greater than 0.1). The cimetidine group experienced significantly (p less than 0.05) less side effects than the surgical group, with respectively 10% and 50% of patients having Visick grade II and above. After one year of maintenance treatment, cimetidine was withdrawn, and ulcer recurred in 71.4% within six months. The relapse rates between the two groups were significantly different by life-table analysis (p less than 0.01). We conclude that cimetidine was as effective as surgery in preventing relapse of postsurgical recurrent ulcers and had fewer side effects, but indefinitely prolonged therapy appeared necessary.