Gastric acid secretion in patients with duodenal ulcer treated for one year with anticholinergic drugs

Abstract

SUMMARY Ninety patients with duodenal ulcer, divided randomly into three groups, were treated continuously for one year with either glycopyrronium, 1-hyoscyamine (as a sustained-release preparation) or inert tablets. Dosage with active tablets was so adjusted that the patient experienced definite but tolerable side-effects. Basal and maximal gastric acid secretion were measured immediately before and one week after cessation of treatment. There was no significant change in the means of these measurements in patients who received placebo or 1-hyoscyamine. In Wales, 1966) it was stated that reduced levels of acid secretion persisted for up to 30 months after the drug had been stopped. This maintained reduction was thought to reflect the course of the underlying disorder rather than a direct effect of the anticholinergic drug.In this report, we describe our findings in a group of 90 patients with duodenal ulcer who were treated continuously for one year with anticholinergic drugs. PATIENTS AND METHODSAll patients were male, had a duodenal ulcer recently demonstrated by radiograph, and had had symptoms within six months of the first examination. They were taking part in a trial of long-term anticholinergic therapy, full details of which will be published shortly, and were allocated randomly to one of three groups.

A controlled trial of glycopyrronium and l-hyoscyamine in the long-term treatment of duodenal ulcer

“…There was no significant change in maximal acid output in any of the groups. These findings have been reported in detail elsewhere (Kaye, Beck, Rhodes, and Sweetnam, 1969). There was no correlation between the symptom scores for either day pain or night pain with the basal or maximal acid secretion.…”

Spontaneous and Persisting Decrease in Maximal Acid Output

“…A decrease in acid ouput in patients with duodenal ulcer after prolonged administration of anticholinergic drugs has been attributed to the drug (Hunt and Wales, 1966) or to a spontaneous fluctuation in parietal cell mass independently of the drug (Kaye, Beck, Rhodes, and Sweetman, 1969). Since a spontaneous decrease in maximal acid output is not uncommon in patients with duodenal ulcer, as shown by this study, caution should be exercised before attributing a decrease in acid output to the drug administered.…”

Comparison of Dose-Response Curves with Subcutaneous Histamine and Pentagastrin. Variations of Acid Secretion in Relation with Time

“…In literature, both a decrease and an increase in PAO has been reported with placebo and prolonged anticholinergic drugs [5,9]. However, the inter pretation of results of these studies [5,9] was rather difficult as (1) values of PAO were obtained with a single dose rather than with dose-response curves, (2) the mean values were only compared without assessing the signi ficance of both high and low values observed, (3) patients were on prolonged anticholinergic therapy.…”

“…However, the inter pretation of results of these studies [5,9] was rather difficult as (1) values of PAO were obtained with a single dose rather than with dose-response curves, (2) the mean values were only compared without assessing the signi ficance of both high and low values observed, (3) patients were on prolonged anticholinergic therapy. In contrast, in the present study highest values of acid output at different intervals of time were compared on dose-response curves with a view to eliminate the possibility of the observed changes being due to errors in the method (e.g.…”