title: Role of free radical scavengers in the management of refractory duodenal ulceration. A new approach.
abstract: This prospective randomized double blind study examined the influence of free radical scavengers on the healing and recurrence of refractory duodenal ulceration. To this end, allopurinol (50 mg, four times a day) -a hydroxyl radical scavenger and an inhibitor of xanthine oxidase, the enzyme which forms superoxide radicals--and dimethyl sulfoxide (DMSO, 500 mg, four times a day)--a hydroxyl radical scavenger--were administered orally. Three hundred and sixty-three consecutive patients with duodenal ulceration that did not heal despite 3 months of treatment with cimetidine, who were cigarette smokers and social drinkers, were randomized to receive 800 mg cimetidine twice a day alone or with either allopurinol or DMSO. In 315 patients who were evaluable for efficacy analysis, the healing rate at 8 weeks was, for cimetidine alone, 60%; for cimetidine with DMSO, 100%; and for cimetidine with allopurinol, 100%. The healing efficacy of cimetidine was therefore significantly (P < 0.01) heightened by DMSO and allopurinol. The patients whose ulcers healed were instituted on maintenance treatment for 1 year and received 800 mg cimetidine at bedtime alone or with either DMSO or allopurinol. In 218 patients who were evaluable for efficacy analysis, the cumulative relapse rate at 1 year was, for cimetidine alone, 29%; for cimetidine with DMSO, 8%; and for cimetidine with allopurinol, 7% DMSO with cimetidine and allopurinol with cimetidine were, therefore, superior to cimetidine alone (P < 0.01) in preventing ulcer relapse. The results suggest that oxygen-derived free radicals are implicated in the mechanism of refractory duodenal ulceration and that scavenging these radicals stimulates healing and reduces recurrence of the ulceration.
authors.affiliation: University Department of Surgery, Medical City, Baghdad, Iraq.
authors.forename: A S
authors.initials: AS
authors.lastname: Salim
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D000493:Allopurinol / Q000008:administration & dosage / Q000627:therapeutic use*; D002927:Cimetidine / Q000008:administration & dosage / Q000627:therapeutic use; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy*; D005260:Female; D016166:Free Radical Scavengers; D006801:Humans; D017665:Hydroxyl Radical / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors
chemical_list: D016166:Free Radical Scavengers; D017665:Hydroxyl Radical; D000493:Allopurinol; D002927:Cimetidine; D014969:Xanthine Oxidase; D004121:Dimethyl Sulfoxide