Ulcer Healing and Relapse Prevention by Ranitidine in Peptic Ulcer Disease

Abstract

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).

Gastrointestinal Disease Control After Histamine2‐Receptor Antagonist Dose Modification for Renal Impairment in Frail Chronically Ill Elderly Patients

“…The level of disease control (approximately 65%) in this study is consistent with the 1‐year remission rates during maintenance therapy with standard dosage of H 2 RAs for peptic ulcer disease and gastroesophageal reflux disease in previous studies 25–31 . This finding suggests that effective GI‐disease management was achieved in patients with adjusted and unadjusted H 2 RA dosage.…”

“…In this case, a greater number of adverse GI events related to H 2 RA dosage reduction may be unrecognized when compared with a potentially higher number of events in a more seriously ill population with potentially more risk factors for GI disease recurrence. Although this possibility cannot be entirely discounted, the similarity in the rate of GI disease control in the patients in Group 1 compared with previous studies using standard H 2 RA dosages reduces its likelihood 25–31 . In addition, there is no evidence that larger‐than‐standard H 2 RA dosages (i.e., unadjusted dose with renal impairment) are generally clinically superior for GI disease control in more seriously ill patients, and this practice is not routinely recommended 25–28,35 …”

“…The level of disease control (approximately 65%) in this study is consistent with the 1-year remission rates during maintenance therapy with standard dosage of H 2 RAs for peptic ulcer disease and gastroesophageal reflux disease in previous studies. [25][26][27][28][29][30][31] This finding suggests that effective GI-disease management was achieved in patients with adjusted and unadjusted H 2 RA dosage. However, because peptic ulcer disease can present with atypical symptoms or an absence of symptoms in elderly people, the true rate of GI symptoms may be underestimated in both groups.…”

“…Although this possibility cannot be entirely discounted, the similarity in the rate of GI disease control in the patients in Group 1 compared with previous studies using standard H 2 RA dosages reduces its likelihood. [25][26][27][28][29][30][31] In addition, there is no evidence that larger-than-standard H 2 RA dosages (i.e., unadjusted dose with renal impairment) are generally clinically superior for GI disease control in more seriously ill patients, and this practice is not routinely recommended. [25][26][27][28]35 The unexpectedly higher incidence of all-cause mortality in Group 2 suggests that patients in Group 2 were more ill than those in Group 1 and may explain why their H 2 RA dose was not decreased.…”

Management of peptic ulcer disease not related to Helicobacter

“…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 .…”