A CONTROLLED-STUDY OF RANITIDINE FOR THE PREVENTION OF RECURRENT HEMORRHAGE FROM DUODENAL-ULCER

Background. Hemorrhage is the most common complication of duodenal ulc er disease, but there is little information about the effectiveness an d safety of long-term maintenance therapy with histamine H-2-receptor blockers. Methods. We conducted a double-blind study in patients with endoscopically documented hemorrhage from duodenal ulcers. Patients we re 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), a t exit from the study, and when a patient had persistent ulcer symptom s 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 stu dy medication. Results. The two groups were similar at entry, which us ually occurred about three months after the index hemorrhage. After a mean follow-up of 61 weeks, 3 of the 32 patients treated with ranitidi ne had recurrent hemorrhage, as compared with 12 of the 33 given place bo (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.