THE MANAGEMENT OF REFRACTORY GASTRIC-ULCER USING H-2-RECEPTOR ANTAGONISTS

Background: There is little information on the natural history of refr actory gastric ulcer, defined as nonhealing on cimetidine greater than or equal to 1 g daily given for at least 3 months. Setting: A distric t general hospital serving an industrial population. Methods: Patients with refractory gastric ulcer had their treatment extended and/or the dose increased, and upon healing the majority were put on maintenance treatment with cimetidine 400 mg nightly or 1 g daily and their progr ess was followed. Results: Of 536 patients with gastric ulcer, 74 (14% ) were refractory. Fifty of the 74 (68%) refractory gastric ulcer pati ents were refractory on their very first course of cimetidine. They ha d no distinguishing demographic features. Healing occurred in 62 patie nts (84%) after a mean treatment period of 11.1 months; 28 patients re quired cimetidine greater than or equal to 2 g daily. Eleven of 23 (48 %) patients relapsed on maintenance with cimetidine 400 mg compared wi th seven of 24 (29%) on 1 g daily. A total of 22 out of 62 (35%) relap sed: nine had a second refractory recurrence but none thereafter. Elev en patients were operated upon, seven for failed medical treatment. On ly two patients eventually proved to have malignant disease. Conclusio ns: Refractory gastric ulcer is uncommon, transient and rarely maligna nt. Most patients can be satisfactorily managed medically.