Eighteen patients with duodenal, gastric or jejunal
ulcers, resistant to at least 3 months treatment with
histamine H2-receptor antagonists, singly or in combination with other
anti-ulcer drugs, were treated with 40 mg
omeprazole once daily for up to 8 weeks. All
ulcers healed, the majority within two weeks. After
ulcer healing patients were given maintenance
therapy with high doses of
cimetidine or
ranitidine. Of 15 patients on maintenance
therapy with H2-receptor antagonists, 12 (80%) developed a relapse after a period ranging from 3 to 52 weeks. Two patients were lost to follow-up. After re-healing on 40 mg
omeprazole, two patients were given 20 mg
omeprazole daily as maintenance
therapy but relapses occurred again after 14 and 26 weeks respectively. After re-healing on 40 mg
omeprazole, these two patients and one additional patient received maintenance
therapy with 40 mg
omeprazole daily. At present these three patients have been relapse-free for periods varying from 16 to 52 weeks. No side effects were registered during treatment with
omeprazole. It is therefore concluded that
omeprazole is highly effective in healing refractory
peptic ulcers and that
omeprazole maintenance
therapy may be useful for prevention of relapse. Patients are sometimes seen with peptic ulceration which appears resistant to
therapy with
histamine H2-receptor antagonists,
colloidal bismuth subcitrate,
sucralfate or
pirenzepine, either given as monotherapy for a prolonged period of time or as combination
therapy. Usually the reason for such therapeutic failure remains obscure. Whether virtually total abolition of
acid secretion will allow
ulcer healing in these circumstances is unknown.(ABSTRACT TRUNCATED AT 250 WORDS)