title: A comparison of low-dose maintenance treatment with enprostil against ranitidine in the prevention of duodenal ulcer recurrence.
abstract: Enprostil, a prostaglandin E2 analogue, is effective in healing acute duodenal ulcer but its value in preventing recurrence, when given daily for maintenance therapy, is uncertain. In this three-centre study we compared enprostil and ranitidine maintenance therapy; the latter is known to reduce duodenal ulcer relapse rates. Patients whose duodenal ulcers had been healed by treatment with an H2-receptor antagonist were randomized to receive single-blind treatment with either 35 micrograms enprostil (n = 64) or 150 mg ranitidine (n = 64) at bedtime for periods of up to 1 year. Endoscopy was routinely performed at 3 months at one centre, and at 6 and 12 months at all three centres, or whenever ulcer symptoms recurred. Clinical assessment and laboratory investigations were performed every 3 months. Relapse, defined as recurrent ulcer with or without pain, or erosions with pain, was significantly greater in patients on enprostil, the comparative rates at 3, 6 and 12 months were: enprostil 23, 31 and 36% ranitidine 6, 12 and 17% (P = 0.013; P = 0.03 and P = 0.03, respectively). Thirty-one patients reported adverse events, the most common being headache (enprostil = 6, ranitidine = 2) and mild diarrhoea (enprostil = 6, ranitidine = 0). Four patients on enprostil were withdrawn for adverse events, although none terminated because of diarrhoea. There were no clinically significant changes in haematology or biochemistry. Enprostil may reduce duodenal ulcer relapse but at a dose of 35 micrograms nightly, it is less effective than 150 mg ranitidine nightly.
authors.affiliation: District General Hospital, Rotherham, UK.
authors.forename: K D
authors.initials: KD
authors.lastname: Bardhan
authors.forename: P
authors.initials: P
authors.lastname: Morris
authors.forename: R F
authors.initials: RF
authors.lastname: Hinchliffe
authors.forename: J H
authors.initials: JH
authors.lastname: Saunders
authors.forename: B R
authors.initials: BR
authors.lastname: MacDougall
authors.forename: J M
authors.initials: JM
authors.lastname: Bold
authors.forename: P R
authors.initials: PR
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D000536:Aluminum Hydroxide / Q000627:therapeutic use; D004338:Drug Combinations; D004381:Duodenal Ulcer / Q000517:prevention & control*; D016099:Endoscopy, Gastrointestinal; D016620:Enprostil / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008276:Magnesium Hydroxide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D011899:Ranitidine / Q000627:therapeutic use*; D012008:Recurrence; D016037:Single-Blind Method; D012907:Smoking
chemical_list: D004338:Drug Combinations; C013591:aluminum hydroxide, magnesium hydroxide, drug combination; D000536:Aluminum Hydroxide; D011899:Ranitidine; D016620:Enprostil; D008276:Magnesium Hydroxide