Randomised study of the influence of non-steroidal anti-inflammatory drugs on the treatment of peptic ulcer in patients with rheumatic disease.

Abstract

Sixty-seven patients with rheumatic disease, treated with non-steroidal antiinflammatory drugs (NSAIDs), entered a controlled trial with a diagnosis of duodenal (n=51), gastric (n=14), or gastric and duodenal (n=2) ulcers. The main objectives of the study were a comparison of ranitidine and sucralfate in ulcer treatment, and to observe the influence of continued NSAID administration during peptic ulcer therapy. Ulcers healed within nine weeks in 52 patients. The mean healing time was similar in 27 patients given ranitidine 150 mg bd (4.9 weeks) and 25 patients given sucralfate 1 g qid (4.6 weeks). In patients with unhealed ulcers after nine weeks of treatment, healing was obtained in seven after further therapy for 3-9 weeks. Of the 30 patients who continued NSAIDs during treatment with either ranitidine or sucralfate, 23 ulcers healed (mean healing time: 5-0 weeks). Of 32 patients in whom NSAIDs were stopped, ulcer healing was documented in 29 (mean healing time: 4.6 weeks). The difference in healing rates was not statistically significant (p>O-10). The outcome of ulcer treatment did not differ in patients with rheumatoid arthritis and patients suffering from osteoarthritis. During a 12 month follow up 14 symptomatic ulcer recurrences were recorded.

Superiority of Lansoprazole vs Ranitidine in Healing Nonsteroidal Anti-inflammatory Drug–Associated Gastric Ulcers

“…[5][6][7] In contrast, a high-dose histamine 2 (H 2 )-receptor antagonist or a proton pump inhibitor is needed to heal ulcers if the NSAID therapy must be continued, [7][8][9][10] although NSAID use may delay gastric ulcer healing with H 2 -receptor antagonists. 6,7 Our large, double-blind, multicenter, randomized, parallel-group study was designed to identify the optimal antisecretory therapy for healing of gastric ulcer in patients receiving NSAIDs by comparing the healing rates of lansoprazole with those of the H 2 -receptor antagonist ranitidine hydrochloride while patients continued using their NSAIDs.…”

Misoprostol—a Logical Therapeutic Approach to Gastroduodenal Mucosal Injury Induced by Non-Steroidal Anti-Inflammatory Drugs?

“…T h e results of all 11 published controlled trials of H, blockers in the healing of NSAID-induced lesions or ulcers while NSAID use was continued are shown in Table 5. In these 11 studies, H, blockers were no better than placebo or comparator in eight (105,(108)(109)(110)(111)(112)(113). In one study (114) cimetidine at a dose of 800mg once daily showed an improvement over placebo healing rates of gastroduodenal lesions (including ulcers) of 8",, (NS), compared with 14"" in the 400 mg cimetidine b.d.…”

Treatment and chemoprevention of NSAID-associated gastrointestinal complications

“…23 Manniche et al performed an open-label study comparing ranitidine 150 mg twice daily with sucralafate 1 g 4 times daily in patients with NSAID-associated peptic ulcer disease. 24 Half of the patients in each treatment group were allowed to continue NSAID therapy while the other half was given an alternative non-NSAID analgesic medication. The overall healing rates were comparable between the two groups (81% for ranitidine, and 84% for sucralafate) at 9 weeks.…”

“…Healing rates were improved in patients who discontinued NSAIDs during primary treatment, 92% versus 85%, respectively. 24 There have been no randomized trials to date comparing misoprostol to H 2 RAs in the primary treatment of NSAIDassociated peptic ulcer disease.…”