Skip to main content
Gut logoLink to Gut
. 1988 Feb;29(2):181–187. doi: 10.1136/gut.29.2.181

Influence of ulcer healing agents on ulcer relapse after discontinuation of acute treatment: a pooled estimate of controlled clinical trials.

G Dobrilla 1, P Vallaperta 1, S Amplatz 1
PMCID: PMC1433311  PMID: 2894337

Abstract

Whether or not the incidence of ulcer relapse varies according to the drug used to produce initial healing is a controversial matter. We tackled this problem using data from 15 eligible trials from 25 published controlled trials in patients followed up for six to 12 months. Pooled estimates of differences in ulcer relapse incidence between patients initially healed with H2-antagonists and patients initially healed with non-H2-antagonist drugs were calculated. The overall incidence of relapse in patients healed with comparator drugs is 11 percentage units lower at six and 12 months, than that observed in H2-antagonist-healed patients. The confidence intervals are +/- 8% at six months and +/- 7% at 12 months. These data suggest the existence of a different effect on relapse incidence for the entire class of comparator drugs taken as a whole, compared with H2-antagonists. On considering the non-H2-antagonists singly, this conclusion holds good only in the case of tripotassium dicitrato bismuthate.

Full text

PDF
181

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achord J. L. Gastric pepsin secretion after prolonged use of cimetidine. Am J Gastroenterol. 1980 Dec;74(6):490–492. [PubMed] [Google Scholar]
  2. Bytzer P., Lauritsen K., Rask-Madsen J. Symptomatic recurrence of healed duodenal and prepyloric ulcers after treatment with ranitidine or high-dose antacid. A 1-year follow-up study. Scand J Gastroenterol. 1986 Aug;21(6):765–768. doi: 10.3109/00365528609011115. [DOI] [PubMed] [Google Scholar]
  3. Chisholm J. C., Jr Ranitidine hydrochloride-induced hypergastrinemia. J Natl Med Assoc. 1985 Apr;77(4):303–304. [PMC free article] [PubMed] [Google Scholar]
  4. Danielsson A., Ek B., Steen L. Effect of fifteen months of double-blind treatment with cimetidine and placebo on peptic ulcer recurrence. Eur J Clin Pharmacol. 1981;19(5):335–341. doi: 10.1007/BF00544583. [DOI] [PubMed] [Google Scholar]
  5. Festen H. P., Lamers C. B., Tangerman A., van Tongeren J. H. Effect of treatment with cimetidine for one year on gastrin cell and parietal cell function and sensitivity to cimetidine in patients with duodenal or gastric ulcers. Postgrad Med J. 1980 Oct;56(660):698–701. doi: 10.1136/pgmj.56.660.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Forrest J. A., Fettes M. R., McLoughlin G. P., Heading R. C. Effect of long-term cimetidine on gastric acid secretion, serum gastrin, and gastric emptying. Gut. 1979 May;20(5):404–407. doi: 10.1136/gut.20.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Frislid K., Aadland E., Berstad A. Augmented postprandial gastric acid secretion due to exposure to ranitidine in healthy subjects. Scand J Gastroenterol. 1986 Jan;21(1):119–122. doi: 10.3109/00365528609034634. [DOI] [PubMed] [Google Scholar]
  8. Gardner M. J., Altman D. G., Jones D. R., Machin D. Is the statistical assessment of papers submitted to the "British Medical Journal" effective? Br Med J (Clin Res Ed) 1983 May 7;286(6376):1485–1488. doi: 10.1136/bmj.286.6376.1485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Guslandi M., Cambielli M., Tittobello A. Carbenoxolone maintenance in cimetidine-healed patients. Scand J Gastroenterol. 1980;15(3):369–371. doi: 10.3109/00365528009181485. [DOI] [PubMed] [Google Scholar]
  10. Hamilton I., O'Connor H. J., Wood N. C., Bradbury I., Axon A. T. Healing and recurrence of duodenal ulcer after treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine. Gut. 1986 Jan;27(1):106–110. doi: 10.1136/gut.27.1.106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hamilton I., Worsley B. W., O'Connor H. J., Axon A. T. Effects of tripotassium dicitrato bismuthate (TDB) tablets or cimetidine in the treatment of duodenal ulcer. Gut. 1983 Dec;24(12):1148–1151. doi: 10.1136/gut.24.12.1148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hansky J., Stern A. I., Korman M. G., Waugh J. Effects of long-term cimetidine on serum gastrin in duodenal ulcer. Dig Dis Sci. 1979 Jun;24(6):468–470. doi: 10.1007/BF01299830. [DOI] [PubMed] [Google Scholar]
  13. Hentschel E., Schuetze K., Dufek W. Relapse rates of duodenal ulcer healed with concentrated antacid or cimetidine. Hepatogastroenterology. 1984 Dec;31(6):266–268. [PubMed] [Google Scholar]
  14. Hentschel E., Schütze K., Dufek W. Rezidive des Ulcus duodeni nach Therapie mit Sucralfat oder Cimetidin. Wien Klin Wochenschr. 1984 Feb 17;96(4):153–156. [PubMed] [Google Scholar]
  15. Hoff G. S., Ruud T. E., Tønder M., Holter O. Doxepin in the treatment of duodenal ulcer. An open clinical and endoscopic study comparing doxepin and cimetidine. Scand J Gastroenterol. 1981;16(8):1041–1042. doi: 10.3109/00365528109181025. [DOI] [PubMed] [Google Scholar]
  16. Ippoliti A., Elashoff J., Valenzuela J., Cano R., Frankl H., Samloff M., Koretz R. Recurrent ulcer after successful treatment with cimetidine or antacid. Gastroenterology. 1983 Oct;85(4):875–880. [PubMed] [Google Scholar]
  17. Kang J. Y., Piper D. W. Cimetidine and colloidal bismuth in treatment of chronic duodenal ulcer. Comparison of initial healing and recurrence after healing. Digestion. 1982;23(2):73–79. doi: 10.1159/000198690. [DOI] [PubMed] [Google Scholar]
  18. Kåresen R., Serch-Hanssen A., Thoresen B. O., Hertzberg J. Crohn's disease: long-term results of surgical treatment. Scand J Gastroenterol. 1981;16(1):57–64. [PubMed] [Google Scholar]
  19. Lee F. I., Samloff I. M., Hardman M. Comparison of tri-potassium di-citrato bismuthate tablets with ranitidine in healing and relapse of duodenal ulcers. Lancet. 1985 Jun 8;1(8441):1299–1302. doi: 10.1016/s0140-6736(85)92793-x. [DOI] [PubMed] [Google Scholar]
  20. Marks I. N., Wright J. P., Lucke W., Girdwood A. H. Relapse rates after initial ulcer healing with sucralfate and cimetidine. Scand J Gastroenterol. 1982 Apr;17(3):429–432. doi: 10.3109/00365528209182081. [DOI] [PubMed] [Google Scholar]
  21. Martin D. F., Hollanders D., May S. J., Ravenscroft M. M., Tweedle D. E., Miller J. P. Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate. Lancet. 1981 Jan 3;1(8210):7–10. doi: 10.1016/s0140-6736(81)90114-8. [DOI] [PubMed] [Google Scholar]
  22. McLean A. J., Harrison P. M., Ioannides-Demos L., Byrne A. J., McCarthy P., Dudley F. J. The choice of ulcer healing agent influences duodenal ulcer relapse rate and long-term clinical outcome. Aust N Z J Med. 1985 Jun;15(3):367–374. doi: 10.1111/j.1445-5994.1985.tb04065.x. [DOI] [PubMed] [Google Scholar]
  23. Miller J. P., Faragher E. B. Relapse of duodenal ulcer: does it matter which drug is used in initial treatment? Br Med J (Clin Res Ed) 1986 Nov 1;293(6555):1117–1118. doi: 10.1136/bmj.293.6555.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mohammed R., Holden R. J., Hearns J. B., McKibben B. M., Buchanan K. D., Crean G. P. Effects of eight weeks' continuous treatment with oral ranitidine and cimetidine on gastric acid secretion, pepsin secretion, and fasting serum gastrin. Gut. 1983 Jan;24(1):61–66. doi: 10.1136/gut.24.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Müller P., Dammann H. G., Simon B. Mehrwöchige Gabe von Ranitidin einmal am Abend: Einfluss auf Säureverhalten und basale Hormonspiegel bei gesunden Probanden. Arzneimittelforschung. 1985;35(9):1472–1474. [PubMed] [Google Scholar]
  26. Pounder R. E. Duodenal ulcers that will not heal. Gut. 1984 Jul;25(7):697–702. doi: 10.1136/gut.25.7.697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Rathbone B. J., Wyatt J. I., Heatley R. V. Campylobacter pyloridis--a new factor in peptic ulcer disease? Gut. 1986 Jun;27(6):635–641. doi: 10.1136/gut.27.6.635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Shreeve D. R., Klass H. J., Jones P. E. Comparison of cimetidine and tripotassium dicitrato bismuthate in healing and relapse of duodenal ulcers. Digestion. 1983;28(2):96–101. doi: 10.1159/000198970. [DOI] [PubMed] [Google Scholar]
  29. Ström M., Gotthard R., Bodemar G., Walan A. Antacid/anticholinergic, cimetidine, and placebo in treatment of active peptic ulcers. Scand J Gastroenterol. 1981;16(5):593–602. doi: 10.3109/00365528109182017. [DOI] [PubMed] [Google Scholar]
  30. Tötterman T. H., Nisell J., Killander A., Gahrton G., Lönnqvist B. Successful treatment of pure red-cell aplasia with cyclosporin. Lancet. 1984 Sep 22;2(8404):693–693. doi: 10.1016/s0140-6736(84)91245-5. [DOI] [PubMed] [Google Scholar]
  31. Witzel L., Halter F., Olah A. J., Häcki W. H. Effects of prolonged metiamide medication on the fundic mucosa. A secretory and histomorphometric study in the rat. Gastroenterology. 1977 Oct;73(4 Pt 1):797–803. [PubMed] [Google Scholar]
  32. Witzel L., Heitz P. U., Halter F., Olah A. J., Varga L., Werner O., Häcki W. H. Effects of prolonged administration of metiamide on serum gastrin, gastrin content of the antrum and gastric corpus, and G-cell population in the rat. Gastroenterology. 1979 May;76(5 Pt 1):945–949. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES