A Controlled Study of Ranitidine for the Prevention of Recurrent Hemorrhage from Duodenal Ulcer

Jensen, Dennis M.; Cheng, Su-Ting; Kovacs, Thomas O.; Randall, Gayle; Jensen, Mary E.; Reedy, Terry J.; Frankl, Harold D.; Machicado, Gustavo A.; Smith, James; Silpa, Michael L.; Deventer, Gary Van

doi:10.1056/nejm199402103300602

Cited by 104 publications

(21 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,5,6 Maintenance antisecretory therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding, despite the fact that only two randomized studies have specifically examined this option in patients with peptic ulcer haemorrhage. 7,8 The first study found no significant difference in the rate of recurrent bleeding between ranitidine maintenance therapy and placebo, but the number of bleeding episodes was so small that a treatment benefit could not be demonstrated; 7 the second study reported significantly fewer episodes of haemorrhage amongst patients taking ranitidine maintenance antisecretory therapy when compared with placebo. 8 Helicobacter pylori infection is the main aetiological factor in peptic ulcer disease.…”

Section: Introductionmentioning

confidence: 99%

Helicobacter pylori eradication therapy vs. antisecretory non‐eradication therapy for the prevention of recurrent bleeding from peptic ulcer

Gisbert

Khorrami

Carballo

et al. 2004

Aliment Pharmacol Ther

133

View full text Add to dashboard Cite

SUMMARYAim: To perform a meta-analysis comparing the efficacy of Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Methods: A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results: In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori eradication therapy group was 4.5%, compared with 23.7% in the non-eradication therapy group without long-term antisecretory therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09-0.37; 'number needed to treat' (NNT), 5; 95% CI, 4-8].In the second meta-analysis, the re-bleeding rate in the H. pylori eradication therapy group was 1.6%, compared with 5.6% in the non-eradication therapy group with maintenance antisecretory therapy (odds ratio, 0.25; 95% CI, 0.08-0.76; NNT, 20; 95% CI, 12-100). When only patients with successful H. pylori eradication were included, the re-bleeding rate was 1%. Conclusions: The treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and eradication therapy should be prescribed to infected patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Helicobacter pylori eradication therapy vs. antisecretory non‐eradication therapy for the prevention of recurrent bleeding from peptic ulcer

Gisbert

Khorrami

Carballo

et al. 2004

Aliment Pharmacol Ther

133

View full text Add to dashboard Cite

show abstract

“…O avanço na terapêutica endoscópica possibilitou abordagem da angiodisplasia intestinal. Vários mé-todos têm sido utilizados para hemostasia, tais como: injeção de soluções na submucosa (soro fisiológico, esclerosantes, vasoconstrictores); e métodos térmicos (cautérios monopolar e bipolar, gás Argônio) 4,5,6,7,8,9 . A predominância das lesões no cólon direito significa risco maior de complicações no tratamento das anomalias vasculares.…”

Section: Discussionunclassified

Novo método para tratamento da angiodisplasia de cólon

Freitas

Santos

Todeschi

et al. 2009

Rev bras. colo-proctol.

View full text Add to dashboard Cite

RESUMO: A utilização da colonoscopia como método de diagnóstico e tratamento possibilitou avanços na abordagem da angiodisplasia de cólon, anomalia vascular responsável por um terço das hemorragias gastrointestinais baixas. Trata-se de paciente com 65 anos, insuficiência renal crônica dialítica e coronariopata grave, apresentando episódios de hematoquezia volumosa ao iniciar uso de agregantes plaquetários, necessitando múltiplas hemotransfusões. Colonoscopia diagnosticou lesões vasculares no ceco, onde existe grande risco de perfuração durante intervenções terapêuticas. Há descrições na literatura do uso de agentes hemostáticos tais como plasma de Argônio e vasoconstrictores, aplicados separadamente. Foi realizado tratamento endoscópico das angiodisplasias com aplicação de Argônio, após elevação das lesões com soro fisiológico, e pela primeira vez descrita no Brasil, acrescentado vasoconstrictor à solução.

show abstract

“…1 Despite a decline in the incidence of uncomplicated duodenal ulcer disease, the number of hospital admissions and operations for ulcer haemorrhage in the USA has remained relatively unchanged since the introduction of histamine H 2 -receptor antagonists. 2,3 Most ulcer deaths, of which there are over 4000 annually in the UK, 4 occur as a consequence of upper gastrointestinal bleeding, shown in a recent UK study to have a mortality rate of 14%. 5 Studies have shown that 20±40% of duodenal ulcer patients bleed within 20 years of diagnosis, and that the risk of further haemorrhage then increases to 50% or more.…”

Section: Introductionmentioning

confidence: 99%

“…4,6 Indeed, half of all patients with bleeding have no prior symptoms to indicate ulcer relapse. 2,7 The management of these patients must, therefore, include strategies both to heal the ulcer and minimize the risk of recurrent bleeding. The three main factors implicated in gastroduodenal injury which affect management are gastric acid, nonsteroidal anti-in¯ammatory drug (NSAID) ingestion and Helicobacter pylori infection.…”

Section: Introductionmentioning

confidence: 99%

“…safe and effective in reducing rebleeding. 2,9,10 Whether NSAIDs cause duodenal ulcers is unclear, but they are associated with duodenal ulcer bleeding and ulcer death, and should be stopped if possible. 11 Successful eradication of H. pylori offers a potential cure of the ulcer diathesis, and there is emerging evidence that it effectively reduces rebleeding.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The long‐term management of patients with bleeding duodenal ulcers

McAlindon

Taylor

Ryder

1997

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Background: Gastrointestinal haemorrhage is a common complication of duodenal ulcers. Patients who bleed are at substantial risk of recurrent bleeding. Aim: To determine whether appropriate therapeutic steps were taken to reduce the risk of recurrent haemorrhage in patients with a bleeding duodenal ulcer. Methods: The management of patients surviving a duodenal ulcer bleed in the University Hospital, Nottingham, was assessed by case‐note review before (1993) and after (1995–1996) institution of clinical guidelines. The following measures aimed at reducing the risk of recurrent haemorrhage were considered appropriate: stopping non‐steroidal anti‐inflammatory drugs (NSAIDs) when these were implicated in bleeding; successful eradication of Helicobacter pylori if present; and long‐term maintenance acid‐suppression therapy. Results: In 1993, appropriate steps were taken to reduce the risk of recurrent haemorrhage in only 48% of cases. Following the institution of guidelines, management improved significantly in 1995–1996 (appropriate in 83% of cases, P<0.001), was associated with increased referral to gastroenterologists (P<0.001), improved patient compliance with follow‐up (P<0.05), and more rigorous attempts to identify (P<0.001) and ensure clearance (P<0.001) of H.␣pylori. Conclusion: In this study, inadequate long‐term management of patients with a bleeding duodenal ulcer was common. This was due to a failure to adopt strategies aimed at reducing the risk of ulcer relapse and rebleeding. The quality of care improved significantly following the institution of guidelines and encouragement to refer to gastroenterologists.

show abstract

A Controlled Study of Ranitidine for the Prevention of Recurrent Hemorrhage from Duodenal Ulcer

Abstract: For patients whose duodenal ulcers heal after severe hemorrhage, long-term maintenance therapy with ranitidine is safe and reduces the risk of recurrent bleeding.

Cited by 104 publications

References 20 publications

Helicobacter pylori eradication therapy vs. antisecretory non‐eradication therapy for the prevention of recurrent bleeding from peptic ulcer

Helicobacter pylori eradication therapy vs. antisecretory non‐eradication therapy for the prevention of recurrent bleeding from peptic ulcer

Novo método para tratamento da angiodisplasia de cólon

The long‐term management of patients with bleeding duodenal ulcers

Contact Info

Product

Resources

About