title: Marked basal gastric acid hypersecretion and peptic ulcer disease: medical management with a combination H2-histamine receptor antagonist and anticholinergic.
abstract: Three children with peptic ulcer disease had recurrent symptoms unresponsive to cimetidine or ranitidine therapy alone. Acid secretory studies showed a marked basal acid hypersecretion, which was atropine-sensitive in two of three patients and was best suppressed by ranitidine in combination with an anticholinergic drug. Marked reduction in acid output following intravenous atropine suggested that the hypersecretion was under vagal, muscarinic control. However, in one patient, large doses of the selective m1-muscarinic antagonist pirenzepine were ineffective in suppressing basal acid hypersecretion. Given the efficacy and safety of drug therapy used in these children over a 3-year period, we conclude that medical management is an effective alternative to surgery for pediatric patients with refractory or recurrent peptic ulcer disease.
mesh_terms: D000293:Adolescent; D002648:Child; D002927:Cimetidine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010276:Parasympatholytics / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000188:drug therapy / Q000378:metabolism*; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use
chemical_list: D006635:Histamine H2 Antagonists; D010276:Parasympatholytics; D000644:Quaternary Ammonium Compounds; D002927:Cimetidine; D011899:Ranitidine