The role of sustained achlorhydria in bleeding peptic ulcer

Abstract

Twenty-five patients with bleeding peptic ulcers were ndomized to receive either ranitidine 50 mg 8 hourly i.v. control group) or a continuous nasogastric antacid infuion at the rate of 0.5 ml/min along with an i.v. injection feimetidine 100 mg/h (treatment group). Twelve patients were included in the control group and 13 in the treatment roup. The mean gastric pH on therapy was significantly igher in the treatment group (7.88 ± 0.37) than in the ontrol group (5.00 ± 0.55) (p < 0.001), and the gastric H was noted to be >7 on 95% of the occasions in the treatment group and on 8.6% of the occasions in the control group. An overall control of bleeding was chieved in 92.3% of the patients in the treatment group and 50% of the patients in the control group (p < .05). Thus, the failure of therapy was significantly more common in the control group than in the treatment group (p < .05), and more patients of the control group had to indergo emergency surgery than that in the treatment group. None of the patients in the treatment group, but 6.6% of the patients in the control group, died during the study period in the hospital stay. We conclude that in patients with bleeding peptic ulcer an intensive medical erapy comprising hourly injections of cimetidine (or aresumably of other H2 blockers) and continuous nasoastric antacid infusion can achieve sustained achlorhyria, better control of bleeding, and reduce the need for emergency surgery.