Abstract
SummaryThree children with peptic ulcer disease had recurrent symptoms unresponsive to cimetidine or ranitidine therapy alone. Acid secretory studies showed a marked basal acid hypersecretion, which was atropinesensitive in two of three patients and was best suppressed by ranitidine in combination with an anticholinergic drug. Marked reduction in acid output following intravenous atropine suggested that the hypersecretion was under vagal, muscarinic control. However, in one patient, large doses of the selective m1‐muscarinic antagonist pirenzepine were ineffective in suppressing basal acid hypersecretion. Given the efficacy and safety of drug therapy used in these children over a 3‐year period, we conclude that medical management is an effective alternative to surgery for pediatric patients with refractory or recurrent peptic ulcer disease.
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