Vagotomy for duodenal ulcer resistant to H2-receptor antagonists.

One hundred and twenty-seven male patients were subjected to antiulcer surgery for duodenal ulcer resistant to H2-receptor antagonist treatment. Fifty-four (group A) had been on conservative treatment for up to 6 months, while the remaining 73 (group B) had been on conservative treatment for more than 6 and up to 20 months. Of the group A, 43 underwent truncal vagotomy with pyloroplasty (group A1) and 11 highly selective vagotomy (group A2). Of group B, 52 underwent truncal vagotomy with pyloroplasty (group B1) and 21 highly selective vagotomy (group B2). Follow-up ranged between 18 and 72 months (mean 37 months). There were one ulcer recurrence in group A1, none in group A2, nine in group B1 and five in group B2, the difference between group A and group B being statistically significant (p less than 0.05). There was significantly higher nonulcer-associated morbidity after truncal than after highly selective vagotomy (p less than 0.05). No significant difference in the degree of peak acid output reduction was observed between the patients with and those without ulcer recurrence. These findings show that the administration of H2-receptor antagonists for more than 6 months in duodenal ulcer patients who, however, fail to have their ulcer healed is associated with high recurrence rate after vagotomy. It is suggested that such patients should undergo vagotomy as soon as they fulfill the criteria of resistance to H2-receptor antagonists. If conservative treatment has lasted for more than 6 months, vagotomy plus antrectomy has to be considered as the surgical treatment for these patients, with the possible cost of higher nonulcer-associated morbidity.

The efficacy of amineptine in the treatment of depressive patients with irritable bowel syndrome.

Patients with irritable bowel syndrome (IBS) often suffer from depression. In view of this, the effect of amineptine on the psychopathological condition of depressive patients with IBS was studied. Forty patients who satisfied the criteria for irritable bowel syndrome and had a Hamilton 24-item score above 15 were randomly assigned to receive either amineptine 200 mg/day or placebo in a double-blind clinical trial. Patients on amineptine were more improved at the end of the trial than patients on placebo (total Hamilton score). Amineptine was more effective on depressive mood, retardation, and cognitive dysfunction. Although these findings should be interpreted with caution because the baseline scores were higher in the amineptine than in the placebo group, they provide some evidence that amineptine may be a useful tool for the management of depressive patients with IBS.

Prophylactic administration of indomethacin for irradiation esophagitis.

This is a double-blind study in which 14 randomly selected patients treated for lung cancer by irradiation, were receiving indomethacin, while 14 patients treated also by irradiation served as controls. The purpose of the study was to investigate a possible protective effect of the drug in irradiation esophagitis. The esophagus was included in the irradiation field in all patients. Histologic findings of esophagitis were not different in the two groups. However, endoscopic esophagitis and symptomatology were milder in the patients who received indomethacin.

Ulcer associated and nonspecific duodenitis treatment by cimetidine.

Of a total of 230 patients subjected to endoscopy for various reasons 16 were found to have duodenal ulcer and duodenitis (group A) and 16 duodenitis but without an ulcer (group B). Duodenal mucosal biopsy was done in both groups and histological confirmation of duodenitis was noted in 9 of the group A and in 10 of group B. Endoscopy after short-term cimetidine treatment in group A patients revealed ulcer healing in 87.5 percent and improvement of duodenitis in 50 percent. In group B the duodenitis improved endoscopically in 43.7 percent. Histology confirmed the improvement of duodenitis in 31.2 percent and 18.7 percent for groups A and B respectively. These differences were not statistically significant. It is concluded that endoscopic duodenitis is not always confirmed histologically and that cimetidine is effective in a proportion of patients with duodenitis in the presence or not of an ulcer.