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Drugs

, Volume 26, Issue 5, pp 439–453 | Cite as

Drugs for the Prevention of Peptic Ulcer Recurrence

  • D. W. Piper
Review Article

Summary

The treatment of chronic peptic ulcer involves the treatment of acute exacerbations and the complications, and the prevention of ulcer recurrence. Several drugs accelerate the initial healing of ulcer and include the H2-receptor antagonists (cimetidine and ranitidine), colloidal bismuth, sucralfate, pirenzepine, carbenoxolone sodium, prostaglandins, high dose antacids and trimipramine.

The long term management of ulcer involves the use of drugs and, in selected patients, surgery. Drugs used in this context include H2-receptor antagonists, pirenzepine, sucralfate and probably prostaglandins when further trial evidence is available. Regimens of long term drug treatment include intermittent treatment and maintenance treatment. The former consists of no active treatment after the ulcer is healed and the treatment of each acute exacerbation when it occurs, this treatment involving any one of the several drug routines mentioned above. If exacerbations are frequent (i.e. more than 2 to 3 years), maintenance therapy with H2-receptor antagonists, pirenzepine or sucralfate is advised. If the ulcer recurs despite long term treatment, it may be healed again using the healing dose of the above agents, and maintenance therapy recommenced if the remission induced by maintenance therapy was several years. If the remission was short, surgery should be advised.

Keywords

Peptic Ulcer Cimetidine Duodenal Ulcer Ranitidine Gastric Ulcer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Alexander-Williams, J.: Personal communication (1981).Google Scholar
  2. Alexander-Williams, J.: Surgical therapy of gastric ulcer; in Frontiers of Gastrointestinal Research, pp. 126–137 (Karger, Basel 1980).Google Scholar
  3. Amdrup, E.; Jensen, H-E.; Johnston, D.; Walker, B.E. and Galigher, J.C.: Clinical results of parietal cell vagotomy (highly selective vagotomy) two to four years after operation. Annals of Surgery 180: 279–284 (1974).PubMedCrossRefGoogle Scholar
  4. Bardhan, K.D.: H2-receptor antagonists in peptic ulcer disease and progress in histamine research; in Torsoli et al. (Eds) H2-Antagonists. European Symposium, pp. 5–14 (Excerpta Medica, Amsterdam, Oxford, Princeton 1980a).Google Scholar
  5. Bardhan, K.D.: Intermittent treatment of duodenal ulcer with cimetidine. British Medical Journal 281: 20–22 (1980b).PubMedCrossRefGoogle Scholar
  6. Bardhan, K.D.: Cimetidine in duodenal ulcer: The present position on H2-antagonists in peptic ulcer disease and progress in histamine research; in Torsoli et al. (Eds) H2-Antagonists. European Symposium, October 18–20, 1979, Capri, Italy (Excerpta Medica, Amsterdam, Oxford, Princeton 1980c).Google Scholar
  7. Baron, J.H. and Londong, W. (Eds): Advances in basic and clinical pharmacology of pirenzepine. Proceedings of the Second International Symposium on Pirenzepine. Scandinavian Journal of Gastroenterology 15(Suppl. 66): 1–114 (1980).Google Scholar
  8. Barr, G.D.; Kang, J.Y.; Canelese, J. and Piper, D.W.: A two year prospective controlled study of maintenance cimetidine and gastric ulcer. Gastroenterology 85: 100–104 (1983).PubMedGoogle Scholar
  9. Bianchi-Porro, G.; Burland, W.L.; Hawkins, B.W. and Petrillo, M.: H2-receptor antagonists in peptic ulcer disease and progress in histamine research; in Torsoli et al. (Eds) H2-Antagonists. European Symposium, pp. 91–98 (Excerpta Medica, Amsterdam, Oxford, Princeton 1980).Google Scholar
  10. Bianchi-Porro, G. and Petrillo, M.: Cimetidine treatment for anastomotic ulceration after partial gastrectomy; short term clinical trial and maintenance study. British Journal of Clinical Practice 34: 337–339 (1980).PubMedGoogle Scholar
  11. Bianchi-Porro, G. and Petrillo, M.: Pirenzepine in the treatment of peptic ulcer disease. Review and commentary. Scandinavian Journal of Gastroenterology 17(Suppl. 72): 299–236 (1982).Google Scholar
  12. Birger-Jensen, K.; Mollmann, K.M.; Rahbek, I. et al.: Prophylactic effect of cimetidine in gastric ulcer patients. Scandinavian Journal of Gastroenterology 14: 175–176 (1979).CrossRefGoogle Scholar
  13. Black, J.W.; Duncan, W.A.M.; Durant, G.J.; Ganellin, C.R. and Parsons, M.F.: Definition and antagonism of H2-receptors. Nature 236: 385–390 (1972).PubMedCrossRefGoogle Scholar
  14. Bodemar, G. and Walan, A.: Maintenance treatment of recurrent ulcer by cimetidine. Lancet 1: 403–407 (1978).PubMedCrossRefGoogle Scholar
  15. Bolin, T.D.; Billington, B.P. and Davis, A.E.: Comparison of ranitidine and cimetidine as maintenance therapy in the prevention of duodenal ulcer recurrence (abstract); in Proceedings of the 25th Annual Scientific Meeting of the Gastroenterological Society of Australia, 2nd to 4th May, 1983, Perth, p. 25 (1983).Google Scholar
  16. Bonnevie, O.: Survival in peptic ulcer. Gastroenterology 75: 1055–1060 (1978).PubMedGoogle Scholar
  17. Boyd, E.J.S.; Peden, N.R.; Browning, M.C.K.; Saunders, J.H.B. and Wormsley, K.G.: Clinical and endocrine aspects of treatment with ranitidine. Scandinavian Journal of Gastroenterology 16(Suppl. 69): 81–83 (1981).Google Scholar
  18. Boyd, E.J.S.; Wilson, J.A.; Peden, N.R. and Wormsley, K.G.: Maintenance treatment of duodenal ulcer with ranitidine; in Misiewicz and Wormsley (Eds) Clinical Use of Ranitidine, pp. 189–191 (The Medicine Publishing Foundation, Oxford 1982).Google Scholar
  19. Brittain, R.T.; Daly, M.J.; Jack, D. et al.: The outline of the animal pharmacology of ranitidine; in Misiewicz and Wormsley (Eds) Clinical Use of Ranitidine, pp. 1–10 (The Medicine Publishing Foundation, Oxford 1982).Google Scholar
  20. Brogden, L.N.; Heel, R.C.; Speight, T.M. and Avery, G.S.: Cimetidine: A review of its pharmacological properties and therapeutic efficacy in peptic ulcer disease. Drugs 15: 93–131 (1978).PubMedCrossRefGoogle Scholar
  21. Brogden, R.N.; Carmine, A.; Heel, R.C.; Speight, T.M. and Avery, G.S.: Ranitidine: A review of its pharmacology and therapeutic use in peptic ulcer disease and other allied conditions. Drugs 24: 267–303 (1982).PubMedCrossRefGoogle Scholar
  22. Burland, W.L.; Hawkins, B.W.; Horton, R.J. and Beresford, J.: The longer term treatment of duodenal ulcer with cimetidine; in Wastell and Lance (Eds) Cimetidine: The Westminster Hospital Symposium, pp. 66–78 (Churchill Livinstone, Edinburgh 1978).Google Scholar
  23. Cargill, J.M.; Peden, N.; Saunders, J.H.B. and Wormsley, K.G.: Very long term treatment of peptic ulcer with cimetidine. Lancet 2: 1113–1115 (1978).PubMedCrossRefGoogle Scholar
  24. Chierichetti, S.M.; Gaetani, M. and Petrin, G. (Eds): Pharmacokinetic and clinical studies on pirenzepine, a new anti-ulcer drug. Scandinavian Journal of Gastroenterology 14(Suppl. 57) (1979).Google Scholar
  25. Classen, M.; Bethge, H.; Brunner, G. et al.: Effect of sucralfate on peptic ulcer recurrence: A controlled double-blind multicentre study. Scandinavian Journal of Gastroenterology 18(Suppl. 83): 61–70 (1983).Google Scholar
  26. Cockel, R.; Dawson, J. and Jain, S.: Ranitidine in the long-term treatment of gastric ulcers; in Misiewicz and Wormsley (Eds) Clinical Use of Ranitidine, pp. 232–238 (The Medicine Publishing Foundation, Oxford 1982).Google Scholar
  27. CURE: Is duodenal ulcer recurrence more common after cimetidine treatment? (Abstract.) Gastroenterology 78(5, Part 2): 1152 (1980).Google Scholar
  28. Dal Monte, P.R.; Bianchi-Porro, G.; Petrillo, M.; Giuliani-Piccari, G.; D’Imperio, N. and Daniotti, S.: Long-term treatment of duodenal ulcer with pirenzepine, a double-blind, placebo-controlled trial. Scandinavian Journal of Gastroenterology 17(Suppl. 72): 225–228 (1982).Google Scholar
  29. de Flora, S.: Cimetidine, ranitidine and their mutagenic nitroso derivatives. Lancet 2: 993–994 (1981).PubMedCrossRefGoogle Scholar
  30. Doll, R.; Hill, I.D.; Hutton, CF. and Underwood, D.J.: Clinical trial of a triterpenoid liquorice compound in gastric and duodenal ulcer. Lancet 2: 793–796 (1962).CrossRefGoogle Scholar
  31. Dronfield, M.W.; Batchelor, A.J.; Larkworthy, W. and Langman, M.J.S.: Controlled trial of maintenance cimetidine treatment in healed duodenal ulcer: Short- and long-term effects. Gut 20: 526–530 (1979).PubMedCrossRefGoogle Scholar
  32. Duncan, W.A.M. and Parsons, M.E.: Reminiscences of the development of cimetidine. Gastroenterology 78: 620–625 (1980).PubMedGoogle Scholar
  33. Edwards, C.R.W. and Riley, A.J.: Endocrine effects of ranitidine: Comparison with cimetidine; in Misiewicz and Wormsley (Eds) Second International Symposium on Ranitidine: The Clinical Use of Ranitidine, pp. 64–68 (Medicine Publishing Foundation, Oxford 1982).Google Scholar
  34. Feely, J.; Wilkinson, G.R. and Wood, A.J.: Reduction of blood flow and propranolol metabolism by cimetidine. New England Journal of Medicine 304: 692–695 (1981).PubMedCrossRefGoogle Scholar
  35. Fritsch, W.-P.; Scholten, T.; Muller, J. and Hengels, K.-J.: New developed drugs: Modes of action and clinical experience; in Holtermüller and Malagelada (Eds) Advances in Ulcer Disease, pp. 427–448 (Excerpta Medica, Amsterdam 1980).Google Scholar
  36. Fry, J.: Peptic ulcer: A profile. British Medical Journal 2: 809–812 (1964).PubMedCrossRefGoogle Scholar
  37. Gough, K.: Different doses of ranitidine in the long-term treatment of duodenal ulcer: Interim analysis; in Misiewicz and Wormsley (Eds) Clinical Use of Ranitidine, pp. 196–200 (The Medicine Publishing Foundation, Oxford 1982).Google Scholar
  38. Gray, G.R.; Smith, I.S.; Mackenzie, I. and Gillespie, G.: Long-term cimetidine in the mangement of severe duodenal ulcer dyspepsia. Gastroenterology 74: 397–401 (1978).PubMedGoogle Scholar
  39. Griebe, J.; Bugge, P.; Gjorup, T.; Lauritzen, T.; Bonnevie, O. and Wulff, H.R.: Long-term prognosis of duodenal ulcer: Follow-up study and survey of doctors’ estimates. British Medical Journal 2: 1572–1574 (1977).CrossRefGoogle Scholar
  40. Gudmand-Høyer, E.; Jensen, K.B.; Krag, E.; Rask-Madsen, J.; Rahbek, I.; Rune, S.J. and Wulff, H.R.: Prophylactic effect of cimetidine in duodenal ulcer disease. British Medical Journal 1: 1095–1097 (1978).PubMedCrossRefGoogle Scholar
  41. Hammer, R.: Muscarinic receptors in the stomach. Scandinavian Journal of Gastroenterology 15(Suppl 66): 5–14 (1980).Google Scholar
  42. Hammer, R.; Berrie, C.P.; Birdsall, N.J.M.; Burger, A.S.V. and Hulme, E.C.: Pirenzepine distinguishes between different subclasses of muscarinic receptors. Nature 283: 90–92 (1980).PubMedCrossRefGoogle Scholar
  43. Hansky, J. and Korman, M.G.: Long-term cimetidine in duodenal ulcer disease. Digestive Diseases and Science 24: 465–467 (1979).CrossRefGoogle Scholar
  44. Heagerty, A.M.; Donovan, M.A.; Castleden, C.M.; Pohl, J.F.; Patel, L. and Hedges, A.: Influence of cimetidine on pharmacokinetics of propranolol. British Medical Journal 282: 1917–1919 (1981).PubMedCrossRefGoogle Scholar
  45. Heathcote, S.V. and Parry, M.: Pirenzepine selectivity inhibits gastric acid secretion: A comparative pharmacological study between pirenzepine and seven other antiacetylcholine drugs. Scandinavian Journal of Gastroenterology 15(Suppl. 66): 15–24 (1980).Google Scholar
  46. Henry, D.A.; Kitchingman, S. and Langman, M.J.S.: The problem of hepatic drug interaction in the clinical use of ranitidine; in Misiewicz and Wormsley (Eds) Second International Symposium on Ranitidine: The Clinical Use of Ranitidine (Medicine Publishing Foundation, Oxford 1982).Google Scholar
  47. Hetzel, D.; Birkett, D. and Miners, J.: Cimetidine interaction with warfarin. Lancet 1: 639 (1979).CrossRefGoogle Scholar
  48. Hetzel, D.J.; Bochner, F.; Hallpike, J.F. and Shearman, D.J.C.: Cimetidine interaction with phenytoin. British Medical Journal 282: 1512 (1981).PubMedCrossRefGoogle Scholar
  49. Hetzel, D.J.; Hecker, R. and Shearman, D.J.C.: Long-term treatment of duodenal ulcer with cimetidine: intermittent or continuous therapy? Medical Journal of Australia 2: 612–614 (1980).PubMedGoogle Scholar
  50. Holtermüller, K.-H.: Goals of medical therapy in ulcer disease; in Holtermüller and Malagelada (Eds) Advances of Ulcer Disease. Proceedings of a Symposium on the Pathogenesis and Therapy of Ulcer Disease, pp. 303–314 (Excerpta Medica, Amsterdam, Oxford, Princeton 1980).Google Scholar
  51. Holtermüller, K.-H. and Malagelada, J.-R. (Eds): Advances in Ulcer Disease. Proceedings of Symposium on Pathogenesis and Therapy of Ulcer Disease (Excerpta Medica, Amsterdam, Oxford, Princeton 1980).Google Scholar
  52. Hunt, R.H.; Walt, R.P.; Trotman, I.F.; Colley, S.; Bewar, E.P.; Frost, R.A.; Shepherd, T.H.; Golding, P.L.; Colin-Jones, D.G.; Misiewicz, J.J. and Milton-Thompson, G.J.: Comparison of ranitidine, 150mg nocte, with cimetidine, 400mg nocte, in the maintenance treatment of duodenal ulcer; in Misiewicz and Wormsley (Eds) Clinical Use of Ranitidine, pp. 192–195 (The Medicine Publishing Foundation, Oxford 1982).Google Scholar
  53. Jensen, K.B.; Møllmann, K.M.; Rahbek, I.; Madsen, J. Rask; Rune, S.J. and Wulff, H.R.: Prophylactic effect of cimetidine in gastric ulcer patients. Scandinavian Journal of Gastroenterology 14: 175–176 (1979).PubMedCrossRefGoogle Scholar
  54. Kang, J.Y. and Piper, D.W.: Cimetidine and colloidal bismuth in treatment of chronic duodenal ulcer. Digestion 23: 73–79 (1982).PubMedCrossRefGoogle Scholar
  55. Kennedy, T.: Personal communication (1981).Google Scholar
  56. Kennedy, T.: A critical appraisal of surgical treatment; in Truelove and Willoughby (Eds) Topics in Gastroenterology 7, pp. 131–148 (Blackwell Scientific Publications, Oxford, London, Edinburgh, Melbourne 1979).Google Scholar
  57. Kirch, W.; Köhler, H.; Spahn, H. and Mutschier, E.: Interaction of cimetidine with metoprolol, propranolol or atenolol. Lancet 2: 531–532 (1981).PubMedCrossRefGoogle Scholar
  58. La Brooy, S.J.; Taylor, R.H.; Ayrton, C. et al.: Cimetidine in the maintenance treatment of gastric ulceration. Hepatogastroenterology 205(Suppl.) (1980).Google Scholar
  59. Langman, M.J.S.: Carbenoxolone in the treatment of chronic gastric ulcer; in Jones, Langman and Mann (Eds) Peptic Ulcer Healing. Recent Studies in Carbenoxolone, pp. 59–69 (MTP Press, Lancaster 1978).Google Scholar
  60. Libeskind, M.: Maintenance treatment of patients with healed peptic ulcer with sucralfate, placebo and cimetidine. Scandinavian Journal of Gastroenterology 18(Suppl. 83): 71–72 (1983).Google Scholar
  61. Machell, R.J.; Ciclitira, P.J.; Farthing, M.J.G.; Dick, A.P. and Hunter, J.O.: Cimetidine in the prevention of gastric ulcer relapse. Postgraduate Medical Journal 55: 393–395 (1979).PubMedCrossRefGoogle Scholar
  62. Marks, I.N.: A sceptical view of medical treatment; in Truelove and Willoughby (Eds) Topics in Gastroenterology 7, pp. 111–130 (Blackwell Scientific Publications, Oxford, London, Edinburgh, Melbourne 1979).Google Scholar
  63. Martin, D.F.; Hollanders, D.; May, S.L.; Ravenscroft, M.M.; Tweedie, D.E.F. and Niller, J.P.: Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate. Lancet 1: 7–8 (1981).PubMedCrossRefGoogle Scholar
  64. Misiewicz, J.J. and Wormsley, K.G. (Eds): The Clinical Use of Ranitidine (Medicine Publishing Foundation, Oxford 1982). Gastroenterology 16 (Suppl. 69): 1–132 (1981).Google Scholar
  65. Misiewicz, J.J. and Wormsley, K.G. (Eds): The Clinical Use of Ranitidine (Medicine Publishing Foundation, Oxford 1982).Google Scholar
  66. Miyake, T.; Ariyoshi, J.; Suzaki, T.; Oishi, M.; Sakai, M. and Eueda, S.: Endoscopie evaluation of the effect of sucralfate therapy and other clinical parameters on the recurrence rate of gastric ulcers. Digestive Diseases and Science 25: 1–7 (1980).CrossRefGoogle Scholar
  67. Mortensen, N.J.Mc. and Eltringham, W.K.: Cimetidine, nitrosation and cancer. Lancet 2: 984 (1981).Google Scholar
  68. Moshal, M.G.; Spitaels, J.M. and Manion, G.L.: Double-blind placebo-controlled evaluation of one year therapy with sucralfate in healed duodenal ulcer. Scandinavian Journal of Gastroenterology 18(Suppl. 83): 57–59 (1983).Google Scholar
  69. Muscroft, T.J.; Taylor, E.W.; Deane, S.A. and Alexander-Williams, J.: Reoperation for recurrent peptic ulcer. British Journal of Surgery 68: 361–377 (1981).Google Scholar
  70. Nagashima, R.: Development and characteristics of sucralfate. Journal of Clinical Gastroenterology 3(Suppl. 2): 103–110 (1981a).PubMedGoogle Scholar
  71. Nagashima, R.: Mechanisms of action of sucralfate. Journal of Clinical Gastroenterology 3(Suppl. 2): 117–127 (1981b).PubMedGoogle Scholar
  72. Paoluzi, P.; Ricotta, G.; Ripoti, F. et al.: Incompatibility and completely healed duodenal ulcer outcome in maintenance treatment: A double blind controlled study. Gut 24: A469 (1983).Google Scholar
  73. Piper, D.W.: Antacid and anticholinergic drug therapy. Clinics in Gastroenterology 2: 361–377 (1973).Google Scholar
  74. Piper, D.W.: The treatment of chronic peptic ulcer; in van der Reis (Ed.) Frontiers of Gastrointestinal Research. The Stomach, Vol. 6, pp. 109–125 (Karger, Basel, Munich, Paris, London, New York, Sydney 1980).Google Scholar
  75. Piper, D.W.: Cimetidine and cancer. Letter to the Editor. Medical Journal of Australia 2: 327 (1981).Google Scholar
  76. Piper, D.W.: Which regimen for the prevention of duodenal ulcer recurrence? Current Therapeutics 23(6): 8–15 (1982a).Google Scholar
  77. Piper, D.W.: Peptic Ulcer (ADIS Health Science Press, New York, Tokyo, Sydney, Auckland, Hong Kong 1982b).Google Scholar
  78. Piper, D.W.; Shinners, J.; Greig, M.; Thomas, J.H. and Waller, S.L.: Effect of healing on natural history of chronic gastric ulcer. Gut 19: 419–424 (1978).PubMedCrossRefGoogle Scholar
  79. Piper, D.W. and Stiel, M.C.: A comparison of a series of newer anticholinergic drugs with atropine as regards their effect on saliva flow and gastric secretion in man. Gut 3: 65–69 (1962).PubMedCrossRefGoogle Scholar
  80. Proceedings of the Second International Sucralfate Symposium. The Seventh World Congress of Gastroenterology, Stockholm, 1982. Scandinavian Journal of Gastroenterology 18(Suppl. 83): 1–84 (1983).Google Scholar
  81. Reimann, I.W.; Klotz, U.; Siems, B. and Frölich, J.C.: Cimetidine increases steady state plasma levels of propranolol. British Journal of Clinical Pharmacology 12: 785–790 (1981).PubMedCrossRefGoogle Scholar
  82. Roberts, R.K.; Grice, J.; Wood, L.; Petroff, V. and McGuffie, C.: Cimetidine impairs the elimination of theophylline and antipyrine. Gastroenterology 81: 19–23 (1981).PubMedGoogle Scholar
  83. Sastry, B.U.R.; in Berger, A. (Ed.) Medicinal Chemistry, pp. 1544–1580 (Wiley Interscience, New York 1970).Google Scholar
  84. Scobie, B.A.: Prognosis of completely healed gastric ulcer. New Zealand Journal of Medicine 89: 344 (1979).Google Scholar
  85. Serlin, M.J.: Ranitidine and Cimetidine: Interactions with other drugs; in Misiewicz and Wormsley (Eds) Second International Symposium on Ranitidine: The Clinical Use of Ranitidine, pp. 87–94 (Medicine Publishing Foundation, Oxford 1982).Google Scholar
  86. Sewing, K.-Fr.: Pharmacodynamics and pharmacokinetics of ranitidine in man; in Misiewicz and Wormsley (Eds) Second International Symposium on Ranitidine: The Clinical Use of Ranitidine, pp. 32–40 (Medicine Publishing Foundation, Oxford 1982).Google Scholar
  87. Stabile, B.E. and Passaro, E.: Recurrent peptic ulcer. Gastroenterology 70: 124–135 (1976).PubMedGoogle Scholar
  88. Ström, M.; Gotthard, R.; Bodemar, G. and Walan, A.: Anticholinergic drugs in the treatment of ulcer disease; in Holtermiiller and Malagelada (Eds) Advances in Ulcer Disease, pp. 395–405 (Excerpta Medica, Amsterdam 1980).Google Scholar
  89. Ström, M.; Gotthard, R.; Bodemar, G. and Walan, A.: Antacidanticholinergic, cimetidine and placebo in the treatment of active peptic ulcer. Scandinavian Journal of Gastroenterology 16: 593–602 (1981).PubMedCrossRefGoogle Scholar
  90. Taylor, P.: Cholinergic agonists; in Gilman et al. (Eds) The Pharmacological Basis of Therapeutics, 6th edition, pp. 91–99 (McMillan Publishing, New York 1980).Google Scholar
  91. Telerman-Toppett, N.; Duret, M.E. and Coërs, C.: Cimetidine interaction with carbamazepine. Annals of Internal Medicine 94: 544 (1981).Google Scholar
  92. Torsoli, A.; Lucchelli, P.E. and Brimblecombe, R.W.: H2-antagonists in peptic ulcer disease and progress in histamine research. European Symposium, October 18–20, 1979, Capri, Italy (Excerpta Medica, Amsterdam, Oxford, Princeton 1980).Google Scholar
  93. Walan, A.: Anticholinergics in the treatment of peptic ulcer. Scandinavian Journal of Gastroenterology 14(Suppl. 55): 84–90 (1978).Google Scholar
  94. Wastell, C. and Lance, P. (Eds): Cimetidine: The Westminster Hospital Symposium (Churchill Livingstone, Edinburgh 1978).Google Scholar

Copyright information

© ADIS Press Australasia Pty Ltd 1983

Authors and Affiliations

  • D. W. Piper
    • 1
  1. 1.Department of MedicineUniversity of Sydney at Royal North Shore HospitalSydneyAustralia

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