Controlled trial of maintenance cimetidine treatment in healed duodenal ulcer: short and long-term effects.

Dronfield, M W; Batchelor, Alicia; Larkworthy, William; Langman, M. J. S.

doi:10.1136/gut.20.6.526

Cited by 69 publications

(6 citation statements)

References 9 publications

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“…The 60% endoscopic relapse rate 1 year after discontinuation of treatment in patients in our study who had healed initially on cimetidine is similar to results of other trials [11,12], Although the difference between this figure and the lesser relapse rate of 47% in patients healing on TDB does not reach sta tistical significance, the trend is similar to another study in which a significantly smaller relapse rate at 1 year in patients who healed on TDB than in those who healed on cime tidine was shown [13], This difference may be related to improvement of the ultrastruc ture of the duodenal mucosa after treatment with TDB [14], However, a more recent re port [15] has shown a recurrence rate at 1 year of 75% irrespective of whether the ini tial healing was with cimetidine or TDB. The fact that 5 of the 6 patients in our study who required both treatments before healing re lapsed, suggests that they had severe duode nal ulcer disease.…”

Section: Discussionsupporting

confidence: 78%

Comparison of Cimetidine and Tripotassium Dicitrato Bismuthate in Healing and Relapse of Duodenal Ulcers

Shreeve¹,

Klass²,

Jones³

1983

Digestion

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A comparison between cimetidine and tripotassium dicitrato bismuthate liquid (TDB) in the treatment of endoscopically diagnosed duodenal ulcer by single-blind randomized trial in 48 patients has shown 18 (75%) out of 24 patients receiving TDB and 13 (54%) out of 24 patients receiving cimetidine healed after 4 weeks’ therapy. Symptomatic improvement within 1 month was seen in 19 patients on TDB and 18 patients on cimetidine, but did not only occur in patients whose ulcers healed. On follow-up, endoscopically proven relapse occurred within 1 year in 47 % of patients whose ulcers had healed during treatment with TDB in comparison with 60% of those healing on cimetidine.

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Section: Discussionsupporting

confidence: 78%

Comparison of Cimetidine and Tripotassium Dicitrato Bismuthate in Healing and Relapse of Duodenal Ulcers

Shreeve¹,

Klass²,

Jones³

1983

Digestion

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“…The same older literature showed that long‐term maintenance treatment with an H 2 ‐RA reduced ulcer recurrences to about 20–30% over 12 months, compared to background recurrence rates of around 70–90% per annum on placebo 56–58 . For maintenance, also, PPIs have been shown to be more effective than H 2 ‐RAs 55 .…”

Section: Management Of Non‐helicobacter Pylori Non‐steroidal Anti‐inmentioning

confidence: 98%

Management of peptic ulcer disease not related to Helicobacter

Yeomans

2002

J of Gastro and Hepatol

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Most peptic ulcers not due to Helicobacter pylori are caused by non-steroidal anti-inflammatory drugs (NSAID), among which an important subset are due to vascular protective ('low-dose') aspirin therapy. Non-steroidal anti-inflammatory drugs ulcers heal quite quickly when treated with a proton pump inhibitor (PPI), even though the NSAID is continued. If the NSAID can be stopped, the ulcers heal readily with either a PPI or a histamine H 2 -receptor antagonist (H 2 -RA). If anti-inflammatory treatment is still needed after ulcers are healed, prophylactic co-therapy with a PPI or misoprostol will reduce the risk of ulcer recurrence by about 60-80%. The alternative of switching to a highly selective cyclooxygenase-2 inhibitor has been shown to reduce the risk of a complicated ulcer by about 50-60%, unless low-dose aspirin treatment needs to be given as well for vascular disease. Idiopathic ulcers are becoming more frequent as H. pylori prevalence falls. Some may be sequelae of previous NSAID ulceration even though the NSAID has been ceased and the original ulcer had healed. These are best treated with an H 2 -RA or a PPI, followed by long-term maintenance with either of these (often in half the healing dosage) to prevent recurrence. Ulcers due to Zollinger-Ellison syndrome and other hypergastrinemia syndromes are rare, and largely beyond the scope of this review.

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“…A long duration of the disease was re ported to slow healing [14,22,49] and to favor relapses [44,50], but in the majority of studies, no unfavorable effect on healing [ 17-19, 30, 32, 33,48, 51 ] and relapse [1,35,42,48,51,53] was observed. Similarly, some studies described slow healing [4,8] and a high relapse rate in males [54], but a major ity of studies was unable to confirm this [1,14, 18, 29, 30, 33, 35, 46-48.…”

Section: Discussionmentioning

confidence: 99%

Presenting Characteristics of Patients with Duodenal Ulcer and Outcome of Medical Treatment in Controlled Clinical Trials Using Cimetidine and Diethylamine Persilate to Treat Ulcer Attack and Diethylamine Persilate and Placebo to Prevent Relapses

Bertschinger¹,

G²,

Aenishänslin³

et al. 1987

Digestion

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A double-blind controlled clinical trial on the medical treatment of the acute episode of duodenal ulcer and the prevention of symptomatic relapses was performed. A total of 164 patients with active duodenal ulcer were either treated with cimetidine 1 g/day (70 patients), diethylaminepersilate (DAP) 1.5 g/day (64 patients) or DAP 2.5 g/day (30 patients). DAP is an allegedly protective agent stimulating mucosal prostaglandin synthesis. Cumulative healing rates after 4 weeks in the 3 groups were 66, 28 and 28 % and after 8 weeks 94, 70 and 63%, respectively. One hundred and five patients with healed duodenal ulcer received, in a second double-blind study, either DAP 0.5 g/day or placebo. Thus, ulcer healing was more rapid with cimetidine than with DAP. DAP did not prevent relapses. No presenting characteristic was associated with slow healing. Three presenting characteristics –smoking, teetotalling and bleeding episode in the past – were associated with early symptomatic relapse. The present study was compared with a previous study performed by the same group of investigators using a similar study protocol. In both trials, an early relapse was associated with smoking. No other presenting characteristic was identified which in both trials was associated with slow healing or early symptomatic relapse. Thus, smoking appears to be the only one of the commonly available presenting characteristics which allows a prediction of the course of duodenal ulcer disease.

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Controlled trial of maintenance cimetidine treatment in healed duodenal ulcer: short and long-term effects.

Cited by 69 publications

References 9 publications

Comparison of Cimetidine and Tripotassium Dicitrato Bismuthate in Healing and Relapse of Duodenal Ulcers

Comparison of Cimetidine and Tripotassium Dicitrato Bismuthate in Healing and Relapse of Duodenal Ulcers

Management of peptic ulcer disease not related to Helicobacter

Presenting Characteristics of Patients with Duodenal Ulcer and Outcome of Medical Treatment in Controlled Clinical Trials Using Cimetidine and Diethylamine Persilate to Treat Ulcer Attack and Diethylamine Persilate and Placebo to Prevent Relapses

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