CIMETIDINE FOR ANASTOMOTIC ULCERS AFTER PARTIAL GASTRECTOMY - RANDOMIZED CONTROLLED TRIAL

In a randomized double-blind multicenter trial, 15 outpatients with endoscopically proved anastomotic ulceration after Billroth I or Billroth II partial gastrectomy received cimetidine, 1 g daily over eight weeks, or a placebo. All patients also received antacid. The ulcer healed completely in all seven cimetidine-treated patients and in one of the eight placebo-treated patients (P<0.01). Ulcers not healed during the double-blind phase of the trial were all subsequently healed on open cimetidine treatment. There was a trend toward improvement of daytime symptoms in favor of cimetidine (P = 0.06), and nighttime symptoms were significantly relieved during the initial four weeks of cimetidine treatment P = 0.02). We conclude that cimetidine, 1 g daily, promotes healing of anastomotic ulcers after partial gastrectomy. (N Engl J Med 301:1077–1080, 1979) ALTHOUGH cimetidine has been found to promote the healing of duodenal ulceration,1 2 3 4 its effect on ulcers recurring after gastric operations remains unclear. The incidence of recurrent ulcers after both Billroth I and II gastrectomies is equally high, between 5 and 10 per cent,5 and recurrence is commonly thought to be a consequence of inadequate abolition of gastric acid production. Therefore, treatment with histamine-H2-receptor antagonists may be effective in this ulcer disease. Several uncontrolled investigations have shown a positive effect of cimetidine on healing of recurrent ulcers after gastrectomy,6 7 8 9 but a single randomized controlled trial failed to detect an. © 1979, Massachusetts Medical Society. All rights reserved.