Are endoscopic and/or histologic findings in gastroduodenal mucosa a predictor of clinical outcome in peptic ulcer disease? A 1-year follow-up study after initial healing with either cimetidine or medium-dose antacid.

Patients with duodenal ulcer (DU; n = 79) or prepyloric ulcer (PPU; n = 39) received cimetidine, 400 mg twice daily, or Novaluzid, 10 ml four times daily (acid-neutralizing capacity, 340 mmol/day), in a multicentre, randomized, double-blind trial. Ulcer healing was almost identical with the two treatments at 4, 6, and 12 weeks in the DU group. Cimetidine was significantly more effective than antacids in alleviating symptoms in PPU disease, with no significant difference in ulcer healing. In the PPU group the symptomatic improvement was inferior irrespective of treatment, and there was a significantly lower healing rate at 4 weeks (p less than 0.05) than in the DU group. The relapse rate over a 1-year follow-up period with no therapy did not differ between the two treatment groups or between the two ulcer groups. No factors in history of disease or endoscopic or histologic variables were of predictive value with regard to delayed healing. The macroscopic appearance of the duodenal and antral mucosae improved significantly when ulcers had healed. In the subgroup of about 50% DU patients who experienced a relapse during the 1-year follow-up period, the histologic scoring of duodenitis remained basically unchanged, contrary to the significant improvement seen in the non-relapsing subgroup. The microscopic changes of the antral mucosa from the time of inclusion to healing seen in the PPU patients were of no predictive value with regard to relapse rate.