Observations on Administration of Chondroitin in Peptic Ulcers

Abstract

The effectiveness of mucin in the treatment of peptic ulcer has usually been ascribed to a local coating effect by which it protects the mucous membrane, its acid combining power, or to an inhibition of peptic digestion. Because we observed beneficial effects from mucin in dogs with liver injury, where the results could hardly be ascribed to a local action, we became interested in its possible systemic effects. Mucin is a glycoprotein, a combination of protein with a carbohydrate radical (the prosthetic group). Chondroitin sulphuric acid, the prosthetic group of chondromucoid, is very similar in composition to the mucoitin that is present in mucin and benefits animals with experimental liver injury as does mucin. Chondroitin and mucin both contain glucuronic acid, which is known to be used by the liver for the detoxification of phenol derivatives and other substances. We felt that a study of a group of patients with peptic ulcer treated with chondroitin might indicate whether any of the action of mucin could be ascribed to a systemic effect produced by the glucuronic acid that it contains. Determinations of the uronic acid content of various batches of commercial mucin by Link's modification of the Lefevre and Tollens method gave results varying from 1.2 to 2.5% glucuronic acid. The theoretical glucuronic acid content of chondroitin is 37.6%; the chondroitin that we have used (at first prepared by us, later made for us by the courtesy of Chappel Bros. Inc.) varied from 95 to 98% pure. We have used 3 to 6 gm. of chondroitin per patient per day in divided doses; this contains an amount of glucuronic acid equivalent to that in the usual daily dose of mucin. Chondroitin is not a gummy material, could hardly be expected to coat the mucous membrane, and was given in the form of the free acid; its action, therefore, cannot be attributed to any local effect. Twenty-two patients with peptic ulcer have been observed over periods of 2 to 9 months. In 20 cases the ulcer was in the duodenum; one case had an ulcer of a gastro-enterostomy stoma, and one had both lesser curvature and duodenal ulcers. In all but 2 cases the ulcer was verified by X-ray, both of these cases presented the classic ulcer syndrome. The history of ulcer prior to chondroitin therapy varied from 1 to 18 years. All the patients had previously been on alkali treatment, which completely relieved the distress in 4 and gave partial relief in all but 4 during the most recent period of alkalinization.