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

ABSTRACT

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.