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

ABSTRACT

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