Misleading Response of Malignant Gastric Ulcers to Cimetidine

Time-dependent morphologic change in depressed-type early gastric cancer

“…Treatment with antisecretory medication such as H 2 RA or PPI can mask symptoms of gastric cancers and even lead to complete or nearly complete resolution of endoscopic signs of malignant ulcer [10][11][12]. Moreover, in Western countries, one-third of the patients with gastroesophageal cancer reportedly have been treated with antisecretory medication before the initial endoscopy [13,18].…”

“…Ulcer formation in EGC is related to tumor location, size, and histologic type, and some portion of ulcerations appears to heal at a rate similar to that seen with benign ulcers [8,9]. Moreover, treatment with antisecretory medication such as H 2 -receptor antagonists (H 2 RA) or proton pump inhibitors (PPIs) before a definite diagnosis can lead to improvement and resolution of the endoscopic signs and may delay detection of EGC [10][11][12][13][14].…”

Early gastric cancer: concepts, diagnosis, and management

“…46,47 It is strongly recommended that patients with ulcer symptoms should undergo endoscopy and biopsy at least once after the symptoms are relieved by medication, and they actually do so in Japan. A prospective study estimated that EGC progressed to advanced cancer in a median period of 37 months, 48 and thus follow-up endoscopy is recommended for patients with recurrent symptoms, so that an EGC can be detected during this slow-growing phase.…”

“…A recent report showed faster recovery, less pain, and shorter hospital stay, for the laparoscopic procedure; however, the only benefit, in terms of quality of life, may be better cosmesis. 46 Laparoscopic local gastric resection. Two types of laparoscopic local resection, laparoscopic wedge resection by the lesion-lifting method 94 and intragastric mucosal resection, 95 have been performed in Japan for EGC.…”

H-2 Histamine Receptors

“…The natural history of gastric ulcer is not well enough delineated yet to allow easy interpretation of treatment. Moreover, even malignant ulcers can become asymptomatic and heal on cimetidine (234). Follow-up of all healed GU by endoscopy is essential.…”