Resistance to medical ulcer therapy--possible reasons and management.
In 112 patients with duodenal ulcer (males, mean age 29, range 18-35) with a history of at least 3 years, and never being treated with H2-antagonists, maintenance therapy with Tagamet was started. All of them had ulcer recurrence when entering the study. The first two months a full dose was applied, after this bedtime doses up to 24 months. Endoscopy was performed at the beginning, after the first and second months and then every two-month period. Gastric secretion was measured every 2-3 months. A resistant ulcer was defined as one 1/not healing within the two initial months, 2/recurring on maintenance treatment.


RESULTS
in 78% the ulcer was healed within one month, in 96% within two months, in the rest within the following 3-4 weeks. Relapses occurred in 21 patients, altogether 27 times. Factors likely to contribute to recurrence included a large ulcer size, longer duration, an inflamed mucosa and--most frequently--heavy smoking. Patients with relapses had higher initial secretory values and smaller decrease during maintenance treatment. Helicobacter pylori (examined in a subgroup) was not clearly associated with ulcer recurrence.
IVth Medical Clinic, Charles University, Prague, Czehoslovakia.
M
M
Jablonská
D000293:Adolescent; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D004384:Duodenoscopy; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000378:metabolism; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists