title: The management of refractory gastric ulcer using H2-receptor antagonists.
abstract: BACKGROUND
  There is little information on the natural history of refractory gastric ulcer, defined as non-healing on cimetidine > or = 1 g daily given for at least 3 months.
  
  
  METHODS
  A district general hospital serving an industrial population.
  
  
  METHODS
  Patients with refractory gastric ulcer had their treatment extended and/or the dose increased, and upon healing the majority were put on maintenance treatment with cimetidine 400 mg nightly or 1 g daily and their progress was followed.
  
  
  RESULTS
  Of 536 patients with gastric ulcer, 74 (14%) were refractory. Fifty of the 74 (68%) refractory gastric ulcer patients were refractory on their very first course of cimetidine. They had no distinguishing demographic features. Healing occurred in 62 patients (84%) after a mean treatment period of 11.1 months; 28 patients required cimetidine > or = 2 g daily. Eleven of 23 (48%) patients relapsed on maintenance with cimetidine 400 mg compared with seven of 24 (29%) on 1 g daily. A total of 22 out of 62 (35%) relapsed; nine had a second refractory recurrence but none thereafter. Eleven patients were operated upon, seven for failed medical treatment. Only two patients eventually proved to have malignant disease.
  
  
  CONCLUSIONS
  Refractory gastric ulcer is uncommon, transient and rarely malignant. Most patients can be satisfactorily managed medically.
authors.affiliation: Department of Gastroenterology, District General Hospital, Rotherham, UK.
authors.forename: G S
authors.initials: GS
authors.lastname: Raju
authors.forename: K D
authors.initials: KD
authors.lastname: Bardhan
authors.forename: C
authors.initials: C
authors.lastname: Royston
authors.forename: J
authors.initials: J
authors.lastname: Beresford
mesh_terms: D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002927:Cimetidine / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011899:Ranitidine / Q000627:therapeutic use; D012008:Recurrence; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology; D013276:Stomach Ulcer / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D002927:Cimetidine; D011899:Ranitidine