Role of histamine-2 receptor antagonists after simple closure of perforated duodenal ulcer--a double blind randomised, controlled study.

INTRODUCTION

Definitive surgery at the time of primary laparotomy for perforated duodenal ulcer is often deferred because of its increased morbidity. However simple closure alone is associated with a high rate of recurrence. In view of this H2 blockers have been administered along with simple closure to promote ulcer healing. Only 4 series have been published so far, all lacking either a control group or endoscopic follow up. The results are contradictory.

AIMS: This study was done to assess the effect of administration of H2 blockers after simple closure on ulcer healing in a randomised, controlled, double blind fashion.

METHODS

One hundred patients were entered in the study. Fifty patients randomly selected either received ranitidine or a placebo after simple closure. Follow up endoscopy was done at 1, 2 and 6 months. If persistence of ulcer was seen at 4 weeks, patients on placebo were converted to ranitidine and those on ranitidine were continued on the drug.

RESULTS

Endoscopically assessed rate of persistent or recurrent ulcer at 4 weeks was 39% in the ranitidine group and 29% in the placebo group. At 6 months the corresponding figures were 33% and 30% respectively. The differences between the two groups were not significant.

CONCLUSIONS

Ranitidine, therefore, does not appear to promote healing of a perforated duodenal ulcer after simple closure.