Among the factors involved in the pathogenesis of
gastric ulcer, the reduced clearing capacity of the stomach seems to play an important role. On this basis,
cisapride, which improves gastrointestinal motility, enhances gastric emptying, and prevents
duodenogastric reflux, may be effective in the treatment of the
gastric ulcer. We randomly allocated 60 consecutive patients, with uncomplicated
antral gastric ulcer (diameter 5-25 mm), into three groups of treatment:
cisapride 20 mg b.i.d. (C),
ranitidine 150 mg b.i.d. (R),
cisapride 20 mg b.i.d. +
ranitidine 150 mg b.i.d. (C+R). Endoscopic examination with biopsy specimens was performed on admission, after 4 weeks and (if
ulcer not healed) after 8 weeks of
therapy. Three patients were lost to follow-up (two in C and one in C+R), and three were withdrawn, due to malignant
ulcer (one case in R) or to side effects (one case of
diarrhea in C, one case of
headache in C+R). Healing rates at 4 weeks were 41.1% in C, 52.6% in R, and 50.0% in C+R; at 8 weeks they were 88.2% in C, 89.4% in R, and 94.4% in C+R. Though the lack of a placebo arm makes final considerations difficult, the results were similar in all three groups, with no evident differences. In conclusion,
therapy with
cisapride appears as effective as H2-blocker alone or combined treatments in healing benign
gastric ulcer.