The aim of this study was to investigate the course of gastric and
duodenal ulcers under
ranitidin and
antacid treatment during continuous
NSAID therapy, and to answer the question of whether
ulcers are an absolute
contraindication for
NSAID treatment. A total of 21 patients (17 females; four males; average age 58 years) with
rheumatoid arthritis (18 patients),
ankylosing spondylitis (two patients), and cervical spine syndrome (one patient) with gastric and/or
duodenal ulcers, demonstrated by endoscopy, entered the study. Because of the severe course of the
rheumatic disease present in every patient, there was a need to continue
NSAID therapy. Gastric or
duodenal ulcers were treated with 300 mg
ranitidin and an
aluminium-
magnesium-hydroxide-containing
antacid with an
acid binding capacity of 280 mval/day. The course of healing of the
ulcers was checked endoscopically and in part by biopsies (
gastric ulcers). Within the period of 31 +/- 11 days, all
duodenal ulcers under observation had healed. Of the
gastric ulcers, 50% had healed completely while the others showed definite improvement.
NSAID-induced
ulcers were located in or close to the pylorus, contrary to the location of
peptic ulcers. These data show that
NSAIDs--if administration is absolutely necessary because of the severe course of the
rheumatic disease--can be continued even in the presence of gastric or
duodenal ulcers when administered with
ranitidin and
antacids. Because of
hemorrhage and perforation in
NSAID-induced
ulcers, close clinical and endoscopic checks are necessary. Failures, even with the use of H2-blockers, have also been described.