Complicated Ulcer Disease Research Articles

Randomized, double-blind comparison of famotidine with ranitidine in treatment of acute, benign gastric ulcer disease

A multicenter, double-blind, randomized controlled trial comparing the efficacy and safety of famotidine with ranitidine in the treatment of acute, benign gastric ulcer disease was coupled with a community-based gastric ulcer disease registry. One hundred ninety-five patients with endoscopically documented gastric ulcer disease were enrolled in the trial and randomly allocated to treatment with either famotidine 40 mg at bedtime or ranitidine 150 mg twice a day. Healing rates were similar in both groups: at four weeks 49% vs 48%, at six weeks 71% vs 69%, and at eight weeks 83% vs 81% for famotidine and for ranitidine, respectively. Pain relief, antacid tablet use, and adverse experiences were also similar in the two groups. Only 25% of patients entered in the gastric ulcer registry were enrolled in the trial. Given that patients with more severe or complicated gastric ulcer disease should be excluded from controlled trials of new drugs, the screening criteria used in the present study be excluded from findings being representative of a quarter of the patients seen in these practices. Therefore, coupling a patient registry with a clinical trial helps determine the applicability of its results. Famotidine 40 mg at bedtime is an effective and well-tolerated treatment of acute, benign gastric ulcer disease and is comparable in efficacy and safety to ranitidine 150 mg twice a day.

Pachydermoperiostosis, hypertrophic gastropathy, and peptic ulcer

Two brothers with pachydermoperiostosis, an autosomal dominant syndrome characterized by digital clubbing, periosteal new bone formation, coarse facial features with thick, furrowed, and oily skin, presented in their twenties with severe complicated duodenal ulcer disease requiring multiple operations. Their father and one paternal uncle also had pachydermoperiostosis and a past history of ulcer dyspepsia. The mother, one sister, two maternal aunts, and one other paternal uncle were healthy. Both brothers had giant hypertrophic gastritis (Ménétrier's disease). Their pentagastrin-stimulated acid output and fasting and meal-stimulated serum gastrin levels were normal, but their serum pepsinogen I and II levels were markedly elevated. The father had hypochlorhydria and a low serum pepsinogen I/II ratio, suggesting atrophic gastritis. This family study raises the possibility that pachydermoperiostosis, hypertrophic gastropathy, and peptic ulcer may be genetically related.

Gastric partitioning for morbid obesity.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

Stress ulcers. A clinical and experimental study showing the roles of mucosal susceptibility and hypersecretion.

Upper-gastrointestinal tract bleeding or perforation, occurring during convalescence from operation or major illness, is frequently lethal. Incidence and mortality rise when the convalescence is stormy. Like steroid ulcers, stress ulcers occur without premonitory symptoms. The first sign of the stress ulcer is usually upper-gastrointestinal tract bleeding or perforation. Improved salvage from stress ulcers has not paralleled survival from the complications of peptic ulcer disease. Massive bleeding and perforation are considered indications for surgery in complicated ulcer disease, yet conservative therapy is often recommended for stress ulcers, due to the complexity of the situations in which these ulcers arise. Because bleeding and perforation are life-threatening, proper therapy of stress ulcer is mandatory. To establish support for clinical observations drawn from a series of 83 stress ulcers, an experimental model, using laboratory animals, was used (details of the experimental technique are described elsewhere). 1 The results of the experiment successfully tested the

POSTVAGOTOMY GASTRIC ATONY.

Introduction Vagotomy and gastric drainage is an increasingly popular procedure in the care of patients with complicated duodenal ulcer disease. The infrequency of major morbidity is in part responsible for the enthusiasm with which this operation has been received. This study is concerned, however, with one significant complication which is peculiarly related to this operation—postvagotomy gastric atony. Definitions Gastric atony is a motor dysfunction of the stomach resulting in profound gastric retention in the absence of organic obstruction. This failure of the stomach to empty must by definition not be secondary to any of the other well-recognized complications such as intraperitoneal abscess, wound infection, pancreatitis, hypokalemia, hyponatremia, hypoproteinemia, thrombo-embolism, pneumonitis, and cardiovascular alterations. The dysfunction must, in addition, be responsible for a prolonged postoperative course , with more than 14 days elapsing between primary surgical intervention and discharge of the patient from the hospital. A protracted postoperative course due to