poor response of non-ulcer dyspepsia cases to gastric acid suppression and its implications on the theories of pathogenesis

We conducted a randomized controlled trial on 67 patients with non-ulcer dyspepsia to test the efficacy of both H2-Histamine receptors blockers [cimetidine in this study] and conventional antacids in treating these cases. We found that cimetidine was more effective than antacids and placebo in the first week of treatment. It reduced the number of pain attacks by 28.2% in the first week. These effect were not significant in subsequent weeks. Antacids reduced the pain attacks by 12.7% and increased pain-free days by 10.4% which is not significantly different from placebo [12.9% and 12% respectively]. In subsequent weeks, neither cimetidine nor antacids were more effective than placebo. We conclude that the benefit from cimetidine in treatment of non-ulcer dyspepsia is transient and brief, while antacids are of no benefit in such cases. This shows that the non-uclcer dyspeptic syndrome is not dependent on increased gastric acid secretion

incidence of compylobacter enteritis in adults and isolation of the organism from blood stream

WE included 114 adult patients with enteritis or gastroenteritis in the study which aims to determine the incidence of compylobacter infection among adults having gastroenteritis or enteritis, and the incidence of compylobacter bactermia in such cases. By means of stool culture, we isolated 8 cases caused by compylobacter. Blood cultures for the same organism were taken from all the 8 cases with compylobacter enteritis but only 1 was positive for growth. We concluded that the incidence of compylobacter enteric infections in the group studied was 7%, among them only one case had bactermia. This shows that although the disease is not uncommon in adults, assoicated bacteraemia is rare

hazardous effect of smoking on healing of duodenal ulcers and on their recurrence rate is not dependent on gastric acid oversecretion

In a prospective, randomised study, we examined newly diagnosed cases of duodenal ulceration for the effect of smoking on the healing of ulcers to find out whether a maintenance dose of H2-Histamine blockers may significantly antagonise the harmful effect of smoking on healing, so that we can examine the role of HCI oversecretion in augmenting the harmful effect of smoking. The study included 57 smoking patients with duodenal ulcers diagnosed by gastroscopy and followed for two years. It showed that following initial treatment with Ranitidine, for a course of 8 weeks, the incidence of recurrence after 4 months was 21% in patients maintained on Ranitidine, and 38% in patients maintained on placebo. The difference which is in favour of H2-Histamine blockers maintenance is however statistically insignificant. Recurrence rate 12 months after initiating therapy was 66.6% for Ranitidine vs 74% for placebo maintenance respectively, P = not significant. Six months later, the recurrence rate was 53. 8% for Ranitidine vs 74% for placebo maintenance respectively, P = not significant. Six months later, the recurrence rate was 53.8% for Ranitidine vs 55.5% for placebo maintenance, P = N.S. At the end of the two-year study, the recurrence rate for Ranitidine was 48% vs 51.8% for placebo maintenance group, P = N.S. We conclude that in the first few months after treatment, giving maintenance dose of H2-Histamine to smokers with duodenal ulcers decreased the incidence of recurrence on the short term but not to a satisfactory significant level, while on the medium and long terms [12-24 months], it offers no real benefit. Stopping smoking seems to be an important factor in preventing the recurrence of healed duodenal ulcers, and patients should be advised of that instead of prescribing the drugs that suppress gastric acid