Three hundred and six (94%) of all consecutive patients with prepyloric or duodenal ulcer disease undergoing highly selective vagotomy at a District General Hospital were followed up after 1 to 10 completed years of observation. The 5- and 10-year cumulative recurrence rates were 11.6% and 16.8%, respectively. These figures were not related to age, sex, duration of ulcer disease, or preoperative peak acid output. Prepyloric ulcers had a significantly higher recurrence rate than duodenal ulcers during the first 5 years but this difference was eliminated at 10 years. The recurrence rates varied highly significantly between different surgeons. The 5-year recurrence rate in patients operated during the first 5-year period amounted to 13.4% and was steadily increasing. A corresponding figure for those operated during the second 5-year period was 5.3% and remained constant after 3 years of observation. This difference might reflect an improved surgical technique initiated by repeated evaluation of the clinical results.
Ranitidine, 300 mg daily, was given to 92 patients with duodenal ulcer (DU), 38 with prepyloric ulcer (PPU), and 21 with gastric corporeal ulcer (GCU). The healing rates at 4 weeks differed for the different types of ulcers (P less than 0.01), being 91% for DU, 68% for PPU, and 81% for GCU. After established ulcer healing, maintenance treatment with either ranitidine, 100 mg twice daily or 150 mg at night, or placebo was given for 1 year or until ulcer relapse in a total of 108 patients--71 with DU, 24 with PPU, and 13 with GCU. There were no significant differences in relapse rates between the two groups treated with active drug or between the three ulcer groups. However, the overall relapse rate in the active drug groups was 16%, against 72% in the placebo group (P less than 0.001).
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