Abstract
A double-blind, randomized, multicenter study was performed to compare the effect of sucralfate (1 g qid) and cimetidine (400 mg bid) in the treatment of prepyloric ulcer. Altogether 142 patients (68 in the sucralfate and 74 in the cimetidine group) with endoscopically confirmed ulcer within 2 cm of the pylorus completed the study. Endoscopic follow up was performed after four weeks and, if the ulcer was not healed, after eight weeks of treatment. After four weeks, 65% of the ulcers in the sucralfate group were healed, compared to 70% in the cimetidine group. There was no significant difference between sucralfate and cimetidine at either time point. The 95% confidence interval for the difference in ulcer healing with sucralfate or cimetidine ranged from +4 to −19% at eight weeks. Said another way, with an observed difference of 7% (83% vs 90%), the 95% confidence limit ranged from 4% in favor of sucralfate to 19% in favor of cimetidine. Symptomatic relief, antacid intake, and side effects did not differ significantly between the two groups. The healing rate of prepyloric ulcer in this study is similar to that reported for duodenal ulcer after four and eight weeks when treated with sucralfate or cimetidine. Sucralfate is safe and as effective as cimetidine in the short-term treatment of prepyloric ulcer.
Similar content being viewed by others
References
Kurata JH, Haile BM: Epidemiology of peptic ulcer disease. Clin Gastroenterol 13:289–307, 1984
Thomas JM, Misiewicz G: Histamine H2-receptor antagonists in the short- and long-term treatment of duodenal ulcers. Clin Gastroenterol 13:501–541, 1984
Lewis JH: Treatment of gastric ulcer. What is old and what is new? Arch Intern Med 143:264–274, 1983
Bodemar G, Walan A: Cimetidine in the treatment of active duodenal ulcers and prepyloric ulcers. Lancet 2:161–164, 1976
Colin-Jones DG: The use of ranitidine in the acute treatment of gastric ulcer. Glaxo Medical Symposia at the British Academy Conference Centre, London, October 7, 1983 (booklet, Theracom)
Tytgat GNJ, Hameeteman W, Van Olffen GH: Sucralfate, bismuth compounds, substituted benzimidazoles, trimipramine and pirenzepine in the short- and long-term treatment of duodenal ulcer. Clin Gastroenterol 13:543–568, 1984
Marks IN, Wright JP, Denyer M, Garish JAM, Lucke W: Comparison of sucralfate with cimetidine in the short-term treatment of chronic peptic ulcers. S Afr Med J 57:567, 1980
Martin F, Farley A, Gagnon M, Bensemana D: Comparison of the healing capacities of sucralfate and cimetidine in the short-term treatment of duodenal ulcers; a double-blind randomized trial. Gastroenterology 82:401–405, 1982
Walan A, Jönsson K-Å, Haglund U, Rydén C-I, Oscarson J, Graffner H, Darle N, Falk A, Karlsson G, Martinsson J, Rydberg B, Jahnberg T, Järnerot G, Tysk K: A multicenter double-blind trial of an antacid four times daily and cimetidine twice daily on duodenal and prepyloric ulcers. Scand J Gastroenterol 19(Suppl 98):49, 1984
Brunner H, Pesendorfer FX, Pötzi R: Ranitidine in the treatment of duodenal and prepyloric ulcer: Comparison of two dosage regimens. J Int Med Res 11:167–172, 1983
Lauritsen K, Bytzer P, Hansen J, Bekker C, Rask-Madsen J: Comparison of ranitidine and high-dose antacid in the treatment of prepyloric or duodenal ulcer. A double-blind controlled trial. Scand J Gastroenterol 19(Suppl 98):3, 1984
Johnson HD, Love AHG, Rogers NC, Wyatt AB: Gastric ulcer blood groups and acid secretion. Gut 5:402–412, 1964
Kelly KA, Malagelada J-R: Medical and surgical treatment of chronic gastric ulcer. Clin Gastroenterol 13:621–634, 1984
Rehnberg O: Antrectomy and gastroduodenostomy with or without vagotomy in peptic ulcer disease. Acta Chir Scand Suppl 515, 1983
Adami H-O, Enander L-K, Enskog L, Ingvar C, Rydberg B: Recurrences 1 to 10 years after highly selective vagotomy in prepyloric and duodenal ulcer disease. Ann Surg 199:393–399, 1984
Lawson HH: A histological assessment of prepyloric ulceration and a hypothesis relating to acid secretion. Scand J Gastroenterology 16(Suppl 67):141–147, 1981
Ström M, Bodemar G, Lindhagen J, Sjödahl R, Walan A: Cimetidine or parietal-cell vagotomy in patients with juxtapyloric ulcers. Lancet II:894–897, 1984
Andersen D, Høstrup H, Amdrup E: Aarhus county vagotomy trial II, an interim report. World J Surg 2:91–97, 1978
Cameron AJ: Aspirin and gastric ulcer. Mayo Clin Proc 50:565–570, 1975
Silvoso GR, Ivey KJ, Butt JH, Lockard OO, Holt SD, Sisk C, Baskin WN, Mackercher PA, Hewett J: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 92:517–520, 1979
Burge H: The etiology of benign lower curve gastric ulcer: Vagotomy and pyloroplasty in its treatment. Ann R Coll Surg 38:349–369, 1966
Dragstedt LR, Woodward ER: Gastric stasis, a cause of gastric ulcer. Scand J Gastroenterol 5(Suppl 6):243–252, 1970
Miller J-L, Malagelada J-R, Longstreth G-F, Liang V: Dysfunctions of the stomach with gastric ulceration. Dig Dis Sci 25(11):857–864, 1980
Du Plessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974–978, 1965
Mohri K, Ikada M, Muryobayashi T: New aspects in the pathogenesis of gastric ulcer. Chir Forum Exp Klin Forsch 189:93, 1980
Graham DY, Akdamer K, Dyck WP, Englert E Jr, Strickland RG, Ackord JL, Belsito AA, Vlaheevic ZR, Kornfield RN, Long WB, Sontag S, Agrawal NM: Healing of benign gastric ulcer: Comparison of cimetidine and placebo in the United States. Ann Intern Med 102:573–576, 1985
Isenberg JI, Peterson WL, Elashoff JD, Sandersfeld MA, Reedy TJ, Ippoliti AF, Deventer GMV, Frankl H, Longstreth GF, Anderson DS: Healing of benign gastric ulcer with low-dose antacid or cimetidine. N Engl J Med 308:1319–1324, 1983
Tarnawski A: Sucralfate: Is it more than just a barrier? Curr Concepts Gastroenterol 9 (Suppl 1), 1984
Brogden RN, Hell RC, Speight TM, Avery GS: Sucralfate: A review of its pharmacodynamic properties and therapeutic use in peptic ulcer disease. Drugs 27:194–209, 1984
Lam SK, Lau WY, Lai CL, Lee NW, Hui WM, Lok A, Ny M, Fok KH, Yu HC: Efficacy of sucralfate in corpus, prepyloric and duodenal-ulcer associated gastric ulcers. Abstract of Third International Sucralfate Symposium. Lisbon September 1984, Am J Med 79:24–31, 1985
Johansson C, Bergström S: Prostaglandins and protection of the gastroduodenal mucosa. Quadrennial Review. The World Congress in Stockholm, Sweden, 21–46, OMGE, OMED, June 14–19, 1982
Tagamet: New dimensions. Hotta K. Symposium at the XIIth International Congress of Gastroenterology. Lisbon, Windermere Communication, SK & F, 93–103, 1984
Glise H, Carling L, Hallerbäck B, Kagevi I, Solhaug J-H, Svedberg L-E, Wählby L: Short-term treatment of duodenal ulcer. A comparison of sucralfate and cimetidine. Scand J Gastroenterol 21:313–320, 1986
Hallerbäck B, Anker-Hansen O, Carling L, Glise H, Solhaug J-H, Svedberg L-E, Wählby L: Short-term treatment of gastric ulcer-a comparison of sucralfate and cimetidine. Gut 27:778–783, 1986
Sherman RA, Hwang ER, Walker JA, Eisinger RP: Reduction in serum phosphorus due to sucralfate. Am J Gastroenterol 78:210–211, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Svedberg, L.E., Carling, L., Glise, H. et al. Short-term treatment of prepyloric ulcer. Digest Dis Sci 32, 225–231 (1987). https://doi.org/10.1007/BF01297045
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01297045