Healing of Duodenal Ulcer with an Antacid Regimen

To determine whether a large-dose antacid regimen is effective in promoting healing of duodenal ulcer, 74 patients with endoscopically proved duodenal ulcer completed a 28-day double-blind clinical trial comparing such a regimen with an inert placebo. The ulcer healed completely in 28 of the 36 antacid-treated as compared to 17 of the 38 placebo-treated patients (P<0.005). The antacid regimen was not more effective than placebo in relieving ulcer symptoms. Presence or absence of symptoms during the fourth treatment week was a poor predictor of presence or absence of an ulcer crater. Ulcers of placebo-treated patients who smoked cigarettes were less likely to heal than those of nonsmokers (P = 0.03). Except for mild diarrhea, no side effects of the antacid regimen were observed. We conclude that a large-dose antacid regimen hastens the healing of duodenal ulcer. (N Engl J Med 297:341–345, 1977) Gastric acid is believed necessary for the formation of duodenal ulcer. Therefore, it is reasonable to assume that reduction of gastric acidity with antacid therapy should hasten healing. The effect of antacid therapy on healing of duodenal ulcer has been evaluated by only one controlled, randomized, double-blind study.¹ When no benefit was shown, support was given to those who believe antacids are useless in ulcer therapy² or should be prescribed only as needed to relieve pain.^3,4 Others disagree with this concept, pointing to experiments demonstrating that large doses of antacid are necessary to reduce gastric acidity in patients with duodenal.