Treatment Of Benign Gastric Ulcer Research Articles

Efficacy and safety of lansoprazole in the treatment of gastric ulcer

Objective: To compare the efficacy and safety of lansoprazole 30 mg and omeprazole 20 mg in the treatment of benign gastric ulcer. Patients and methods: A multicentre, randomized, comparative, double-blind study was conducted in two parallel groups. Patients with a single gastric ulcer over 5 mm in diameter were included in the study. Efficacy was assessed by the ulcer healing rate on endoscopy and symptom relief. A total of 126 patients were included, 60 of whom received lansoprazole. At admission into the trial, the two groups were comparable for demographic data, tobacco and alcohol consumption, symptoms and ulcer size. Results: The cumulative healing rates by intent-to-treat analysis were 82 and 68% at 4 weeks and 93 and 82% at 8 weeks (P=0.04) for lansoprazole and omeprazole, respectively. By per protocol analysis, the healing rates were 88 and 82% at 4 weeks and 100 and 98% at 8 weeks for lansoprazole and omeprazole, respectively. The time to gastric pain relief was 6.6 days for lansoprazole and 11.0 days for omeprazole. The treatment was well tolerated in both groups. Conclusions: Lansoprazole was safe and effective in healing gastric ulcer with a trend towards faster pain relief compared with omeprazole.

Enprostil vs Ranitidine in the Short Term Treatment of Benign Gastric Ulcer

The therapeutic efficacy and tolerability of enprostil at a dosage of 35μg twice daily were compared with the efficacy and tolerability of ranitidine 150mg twice daily in the short term treatment of benign gastric ulcer in a double-blind controlled trial in 43 patients. The healing efficacy of enprostil was not significantly different from that of ranitidine. By week 4 of treatment, the healing rates were 41% (7 of 17 patients) for enprostil and 50% (11 of 22 patients) for ranitidine, and at 8 weeks, 77% (10 of 13 patients) and 91% (20 of 22 patients), respectively. Enprostil was shown to be less efficacious than ranitidine in controlling ulcer symptoms, and its use was associated with a higher incidence of mild adverse reactions, all gastrointestinal.

Comparative study of sucralfate 2 grams twice daily versus sucralfate 1 gram four times daily in the treatment of benign gastric ulcers in outpatients

In a double-blind, randomized study, we compared the healing of gastric ulcer during a twice-daily regimen of 2 g sucralfate or sucralfate 1 g q.i.d. Patients receiving the former therapy received the tablets one-half hour before breakfast and at bedtime. Patients receiving sucralfate 1 g q.i.d. received their therapy 30 minutes before breakfast, lunch, and supper, and at bedtime. The study included 52 patients with endoscopically proven gastric ulcer; 41 patients completed the study. Healing was endoscopically assessed at 8 weeks and 12 weeks. After 8 and 12 weeks the healing rate for sucralfate 2 g b.i.d. was 67% and 92%, respectively; the healing rate of sucralfate 1 g q.i.d, was 59% and 71%, respectively. No statistically significant difference was found between the two regimens. The results suggest that 2 g sucralfate twice daily is as effective in the healing of gastric ulcer as 1 g sucralfate q.i.d.

The relationship between suppression of acidity and gastric ulcer healing rates

We have investigated the relationship between the suppression of acidity by antisecretory drugs for the treatment of benign gastric ulcer and their corresponding ulcer-healing rates. For a variety of antisecretory drug regimens, there was a significant correlation between suppression of 24-h intragastric acidity and ulcer healing rates after 2, 4 and 8 weeks of treatment. There was a lesser degree of correlation between healing and suppression of nocturnal acidity and the association between suppression of acidity and gastric-ulcer healing rates was less marked than that previously described for duodenal ulcer.

Acute treatment of benign gastric ulcer with once‐daily bedtime dosing of cimetidine compared with placebo

This multicentre, double-blind study evaluated the efficacy of cimetidine 800 mg nocte compared to placebo for ulcer healing and pain relief in patients with endoscopically confirmed, benign gastric ulcers treated for up to 8 weeks. Cimetidine accelerated ulcer healing throughout the study. More cimetidine-treated patients (35 of 82, 43%) than placebo-treated patients (26 of 79, 33%) had healed ulcers after 4 weeks of therapy. Similarly, after 6 and 8 weeks of treatment, cimetidine continued to have superior healing rates, 76% (59 of 78, P = 0.02) and 91% (69 of 76, P = 0.02) heal rates for cimetidine recipients compared with 58% (42 of 73) and 74% (52 of 70) for placebo. For every week of the study except the second, a greater proportion of cimetidine-treated patients were free of daytime and night-time pain than placebo-treated patients; the differences were statistically significant for night-time pain. Adverse reaction profiles were similar for the cimetidine and placebo groups. In conclusion, cimetidine 800 mg nocte was comparably safe and significantly more effective than placebo in accelerating healing and relieving pain in the treatment of acute, benign gastric ulcer.

Treatment of Benign Gastric Ulcer: A Comparative Clinical Trial of Rioprostil and Ranitidine

This study is a multicentre, double-blind, double-dummy, two-way, parallel group comparison of the efficacy and safety of rioprostil and ranitidine in the treatment of active gastric ulcer. Ninety-one patients with gastric ulcer are randomly allocated to treatment with either rioprostil 300 micrograms b.d., or ranitidine, 150 mg b.d. The duration of treatment is 4 weeks, or 8 weeks for the patients who are improved but not healed at 4 weeks. Clinical, endoscopic and laboratory assessments are made before treatment, and after each treatment period. Therapeutic success is defined as complete endoscopic healing of the ulcer. At the end of the treatment period, either 4 or 8 weeks, healing rates are 69% in the rioprostil group, and 66% in the ranitidine group; this difference is not significant (p = 0.86). After the first 4 weeks of treatment the healing rates are 44% and 55% in the rioprostil and ranitidine groups, respectively. The incidence of adverse effects is 22% in the rioprostil group, and 7% in the ranitidine group (p = 0.036). Diarrhoea is the most common side effect (12%), but is usually intermittent and mild. We conclude that rioprostil, 300 micrograms b.d., for up to 8 weeks is as effective as ranitidine, 150 mg b.d., in the treatment of benign gastric ulcer.

Mastic in treatment of benign gastric ulcers.

Mastic in treatment of benign gastric ulcers.

Healing of benign gastric ulcer

Misoprostol, a synthetic prostaglandin E1 methyl ester analog with gastric antisecretory and cytoprotective properties, prevents the development of acute experimental gastric and duodenal ulcers in various animal models. This study was designed as a multicenter randomized double-blind parallel-group comparison of the effects of two dosage strengths (25 and 100 micrograms q.i.d.) of orally-administered misoprostol and placebo on the healing of endoscopically-proven benign gastric ulcer in 299 out-patients. Safety was evaluated by comparison of pre- and post-treatment physical examinations, clinical laboratory tests, gastric antral biopsies and monitoring of adverse experiences. A statistically significant difference in gastric ulcer healing rate was seen at eight weeks among the treatment groups in the Intent-to-Treat Cohort: misoprostol 100 micrograms (62.0%), misoprostol 25 micrograms (50.0%), placebo (44.7%). The proportion of subjects healed in up to eight weeks of treatment was greatest in the misoprostol 100 micrograms group in all cohorts. Ulcer pain decreased in all treatment groups in successive weeks and there were no statistical differences among any of the three treatment groups. Diarrhea was the most frequently reported adverse experience: misoprostol 100 micrograms (9.8%), misoprostol 25 micrograms (7.7%), placebo (1.9%). The diarrhea was mild and self-limiting despite continued use of misoprostol. Overall evaluation of gastric antral biopsies showed no adverse changes in the morphology of the antral mucosa. We conclude that misoprostol 100 micrograms q.i.d. for up to eight weeks is safe and effective in the treatment of benign gastric ulcer.

Pirenzepine. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in peptic ulcer disease and other allied diseases.

Pirenzepine is a 'selective' antimuscarinic agent which, unlike classic anticholinergic agents, inhibits gastric acid secretion at lower doses than are required to affect gastrointestinal motility, salivary, central nervous system, cardiovascular, ocular and urinary functions. On a weight basis, pirenzepine has one-tenth to one-eighth the potency of atropine in inhibiting stimulated gastric acid secretion in humans. Extensive controlled trials utilising endoscopy in outpatients with duodenal ulcers indicate that patient response to pirenzepine is dose related. Doses of 100 to 150 mg/day are superior to placebo in promoting duodenal ulcer healing and in diminishing day and night pain and supplementary antacid consumption. At such doses, the efficacy of pirenzepine appears to be superior to that of gefarnate 300 mg/day and generally not significantly different from that of cimetidine 1 g/day in treating duodenal ulcers. A beneficial effect of pirenzepine in the prevention of duodenal ulcer recurrence was apparent in preliminary studies in small numbers of patients, but its efficacy in this regard needs further confirmation and the optimum dosage determined. Less extensive data on the treatment of benign gastric ulcers suggest that pirenzepine 100 to 150 mg/day is superior to placebo and gefarnate 300 mg/day and does not differ significantly from cimetidine 1 g/day promoting gastric ulcer healing. Pirenzepine is well tolerated by most patients, with a low incidence of typical antimuscarinic effects on the gastrointestinal tract, genitourinary system or heart being reported in clinical studies. However, dry mouth and blurred vision are the more common side effects with clinically effective doses. Thus, pirenzepine appears to have relatively selective antimuscarinic activity, although controlled studies comparing pirenzepine and conventional antimuscarinics in patients with peptic ulcer disease have not been reported.

Cimetidine, antacid, and hospitalization in the treatment of benign gastric ulcer: A multicenter double blind study

Two hundred forty patients with benign gastric ulcer were treated in a controlled clinical trial to assess the effect on healing of cimetidine, antacids, and hospitalization. Inpatients and outpatients were randomly assigned to one of three treatments: cimetidine plus antacid, cimetidine plus dummy antacid, or placebo tablet plus antacid. In 206 patients who met criteria for analysis, ulcer healing as shown by endoscopy occurred by 12 days in 11 to 26% and by 42 days in 58 to 76%. There were no significant differences in healing between hospitalized and nonhospitalized patients or between treatment subgroups. Symptomatic response was equivalent in all groups. The median antacid consumption was 328 mEq of in vitro buffering capacity per day. Patients taking antacids experienced significant diarrhea compared with those taking no antacid. This investigation suggests that the effect of cimetidine is equivalent to that of large amounts of antacid, but because a true placebo group was not studied it is not possible to conclude from this study alone whether either agent influenced healing. In contrast to widespread belief, initiation of treatment in the hospital did not enhance healing, but because patients were not randomly assigned to inpatient and outpatient status no final conclusion about the effect of hospitalization on healing can be drawn.

Cimetidine and placebo in the treatment of benign gastric ulcer

Abstract A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14%. At 6 weeks the incidence of healing increased to 60% in the cimetidine group and 41% in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both the cimetidine and placebo groups, relatively liberal intake of a potent antacid occurred, despite recommendations that antacid be taken only for ulcer pain and a low reported frequency of ulcer pain throughout the study. The role of potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Cimetidine and placebo in the treatment of benign gastric ulcer: A multicenter double blind study

A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14%. At 6 weeks the incidence of healing increased to 60% in the cimetidine group and 41% in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both the cimetidine and placebo groups, relatively liberal intake of a potent antacid occurred, despite recommendations that antacid be taken only for ulcer pain and a low reported frequency of ulcer pain throughout the study. The role of potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Operative treatment of benign gastric ulcers

Between the years 1953 and 1963, 1,583 patients at the Henry Ford Hospital were recorded as having gastric ulcer. Of this number 150 (9.4 per cent) underwent operative treatment. Failure to respond favorably after medical treatment and suspicion of malignancy prompted surgical intervention most often. Two operative approaches were commonly employed. Gastric resection plus vagotomy with Billroth I reconstruction was utilized in fifty-three patients. Gastric resection with vagotomy and Billroth II reconstruction was the procedure of choice in twenty-nine patients. Thus, eighty-two patients had gastric resection with vagotomy. There were four recurrences in this group (5 per cent). The second largest group of patients were those upon whom gastric resection was performed without vagotomy. The Billroth I reconstruction was performed thirty-one times and the Billroth II procedure was employed twenty-one times. There were nine recurrences in fifty-two patients, a recurrence rate of nearly 17 per cent. Clearly, in this study, gastric resection with vagotomy gave better results (5 per cent recurrence) than did gastric resection alone (17 per cent recurrence). The over-all recurrence rata for 150 patients was approximately 11 per cent. In eight patients the clinical diagnosis was benign ulcer when, in fact, malignancy was present. In two patients, the tumor was lymphoma. Only one of ten patients died of tumor. Excellent follow-up studies were possible in every patient with a malignant lesion. Adequate gastric resection is effective for these small, unsuspected ulcerocarcinomas. There were four postoperative deaths, a mortality rate of 2.7 per cent. Two patients died of myocardial infarction and two died of pulmonary emboli.

Clinical trial of vagotomy and pyloroplasty in the treatment of benign gastric ulcer

A clinical trial of vagotomy and pyloroplasty in the treatment of benign gastric ulcer was performed in forty-eight patients. The incidence of recurrent gastric ulcers was 15 per cent. The results were satisfactory in patients undergoing emergency operation for massive bleeding from a gastric ulcer if the patient had not been on ulcerogenic drugs. However, the operation has not been as satisfactory as antral resection for the management of intractable gastric ulcer.

Gastric ulcerations. Differentiation and treatment.

Internists and surgeons disagree on whether or not differential diagnosis of benign and malignant ulcers can be made with sufficient accuracy to justify medical treatment. Careful utilization of diagnostic criteria, including exfoliative cytology, and careful observation of the patient during initial weeks of therapy should reduce the margin of error.Resection is the only treatment of value for neoplastic gastric ulcer. In determining treatment of benign gastric ulcer, the high rate of recurrence after medical management must be balanced against the risks of operation and a postresection syndrome following operation.

Evaluation of the Billroth I gastric resection.

Results of the Billroth I operation in duodenal ulcer have been too variable to warrant our complete confidence in the operation. This is academic, since the combined operation (hemigastrectomy plus vagotomy plus gastroduodenostomy) appears to be far superior to eitherad modum Billroth I or II gastric resections for this disease entity. The treatment of benign gastric ulcer by Billroth I distal gastrectomy (usually, antrectomy is sufficient) is generally recognized as exceptionally satisfactory. The Billroth I resection for gastric carcinoma has its advocates and detractors; we have no set convictions concerning this problem. Finally, we believe that there is merit in the conversion of a Billroth II to I anastomosis for the treatment of severe dumping.

Conservatism in the surgical treatment of benign gastric ulcer.

Conservatism in the surgical treatment of benign gastric ulcer.