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Previous Volume 330:382-386 February 10, 1994 Number 6 Next

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ABSTRACT

Background Hemorrhage is the most common complication of duodenal ulcer disease, but there is little information about the effectiveness and safety of long-term maintenance therapy with histamine H₂-receptor blockers.

Methods We conducted a double-blind study in patients with endoscopically documented hemorrhage from duodenal ulcers. Patients were randomly assigned to maintenance therapy with ranitidine (150 mg at night) or placebo and were followed for up to three years. Endoscopy was performed at base line (to document that the ulcers had healed), at exit from the study, and when a patient had persistent ulcer symptoms unrelieved by antacids or had gastrointestinal bleeding. Symptomatic relapses without bleeding were treated with ranitidine; if the ulcer healed within eight weeks, the patient resumed taking the assigned study medication.

Results The two groups were similar at entry, which usually occurred about three months after the index hemorrhage. After a mean follow-up of 61 weeks, 3 of the 32 patients treated with ranitidine had recurrent hemorrhage, as compared with 12 of the 33 given placebo (P<0.05). Half the episodes of recurrent bleeding were asymptomatic. One patient in the ranitidine group withdrew from the study because of asymptomatic thrombocytopenia during the first month.

Conclusions For patients whose duodenal ulcers heal after severe hemorrhage, long-term maintenance therapy with ranitidine is safe and reduces the risk of recurrent bleeding.

Source Information

From the Center for Ulcer Research and Education, UCLA, and the West Los Angeles Veterans Affairs Medical Center, Los Angeles (D.M.J., S.C., T.O.G.K., G.R., M.E.J., T.R., G.V.D.); Kaiser Permanente, Los Angeles (H.F.); Valley Medical Center, Van Nuys, Calif. (G.M.); Ochsner Medical Institutions, New Orleans (J.S.); and Highland Hospital, Oakland, Calif. (M.S.).

Address reprint requests to Dr. Jensen at 44-133 CHS, GI Division, UCLA Center for the Health Sciences, Los Angeles, CA 90024-1684.

Full Text of this Article

Related Letters:

Ranitidine and Recurrent Hemorrhage from Duodenal Ulcer
Loffeld R.J.L.F., van der Putten A.B.M.M., Jensen D. M., Peterson W. L.
Extract | Full Text  
N Engl J Med 1994; 331:53-54, Jul 7, 1994. Correspondence

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