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The management of refractory gastric ulcer using H2-receptor antagonists
G S Raju1, K D Bardhan, C Royston
1Department of Gastroenterology, District General Hospital, Rotherham, UK.
Insights
Refractory gastric ulcers are uncommon and rarely malignant, with most patients achieving healing through extended or increased cimetidine treatment. Maintenance therapy with higher cimetidine doses reduced relapse rates in this patient group.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Limited data exists on the natural history of refractory gastric ulcers.
- Refractory gastric ulcers are defined as non-healing ulcers despite cimetidine treatment (≥1 g daily for ≥3 months).
Purpose of the Study:
- To investigate the natural history and management outcomes of refractory gastric ulcers.
- To evaluate the efficacy of extended or increased cimetidine dosage and maintenance therapy.
Main Methods:
- A retrospective study was conducted at a district general hospital.
- Patients with refractory gastric ulcers received extended or increased cimetidine treatment.
- Healing rates and relapse rates on different maintenance regimens were monitored.
Main Results:
- 14% of gastric ulcer patients (74/536) were refractory, with 68% refractory on initial cimetidine.
- 84% (62/74) achieved healing after a mean of 11.1 months, with 28 requiring cimetidine ≥2 g daily.
- Relapse rates were lower with 1 g daily maintenance (29%) compared to 400 mg nightly (48%); 35% overall relapsed.
Conclusions:
- Refractory gastric ulcer is an uncommon condition with a generally benign and transient course.
- Most refractory gastric ulcers can be managed effectively with medical treatment, including dose adjustments and maintenance therapy.
- Higher maintenance doses of cimetidine appear to reduce relapse rates.
Background:
There is little information on the natural history of refractory gastric ulcer, defined as non-healing on cimetidine > or = 1 g daily given for at least 3 months.
Setting:
A district general hospital serving an industrial population.
Methods:
Patients with refractory gastric ulcer had their treatment extended and/or the dose increased, and upon healing the majority were put on maintenance treatment with cimetidine 400 mg nightly or 1 g daily and their progress was followed.
Results:
Of 536 patients with gastric ulcer, 74 (14%) were refractory. Fifty of the 74 (68%) refractory gastric ulcer patients were refractory on their very first course of cimetidine. They had no distinguishing demographic features. Healing occurred in 62 patients (84%) after a mean treatment period of 11.1 months; 28 patients required cimetidine > or = 2 g daily. Eleven of 23 (48%) patients relapsed on maintenance with cimetidine 400 mg compared with seven of 24 (29%) on 1 g daily. A total of 22 out of 62 (35%) relapsed; nine had a second refractory recurrence but none thereafter. Eleven patients were operated upon, seven for failed medical treatment. Only two patients eventually proved to have malignant disease.
Conclusions:
Refractory gastric ulcer is uncommon, transient and rarely malignant. Most patients can be satisfactorily managed medically.