Twenty-seven adult Nigerian patients with endoscopically proven active
duodenal ulcers have received in a double-blind trial either the
histamine H2 - receptor antagonist cimetidine 1g daily or placebo
tablets of identical appearance for 4 weeks. Fifty-six per cent of the
cimetidine patients and 18% of those receiving placebo had endoscopically completely healed
ulcers and total
pain relief at the completion of trial. This response amounted to clinical cure. An additional 19% of patients in the
cimetidine group experienced clinical improvement either in endoscopic or symptomatic reassessment but not in both, thus leading to a disparity between clinical cure rate (56%), healing rate (69%), and
pain relief (64%). Though therefore significantly better than placebo, this less favourable response to
cimetidine in this study may be due to the short trial period, the disparity between healing and
pain relief rates or to co-existing and persistent antroduodenitis in
ulcer patients as shown on gastroduodenal mucosal biopsies taken at the time of the clinical investigation. There were no untoward clinical laboratory side effects with the exception of the one
cimetidine patient who experienced diarrhoea and a small number who showed slight, asymptomatic rise in plasma
creatinine level. Of particular interest to the reported occurrence of diarrhoea with
cimetidine therapy is the finding in the bacteriological studies of intestinal aspirates and biochemistry estimations for indicanuria in the consenting patients which showed that orally administered
cimetidine 1g daily for 4 weeks neither produced demonstratable alterations in the bacterial content of the small bowel not pathological indicanuria, thereby excluding
bacterial overgrowth syndrome as a therapeutic hazard in the clinical application of
cimetidine.