Role of histamine H2 receptor antagonists in nonoperative management of gastroduodenal ulcer haemorrhage.

Acute massive gastroduodenal ulcer haemorrhage may be caused by peptic ulcers or acute stress ulcerations. The former is a clinical problem that is met with fairly frequently, associated with a mortality of 10-20%. Bleeding stress ulcerations are less common but have a still more serious prognosis. The histamine H2-receptor antagonist cimetidine has in one large study been demonstrated to reduce mortality in ulcer haemorrhage, and in other studies beneficial effects have been found in elderly patients; above all in elderly gastric ulcer patients. Other authors again find no beneficial effects. The inconsistent results can be due to the fact that other factors, such as high age, profuse bleeding, and concomitant disabling diseases, are more important for the outcome than inhibiting acid secretion with H2-receptor antagonists. In stress ulcers, H2-receptor antagonists have been shown to be effective as part in the prophylactic treatment. Antacids might be more effective, but high doses are often required.