{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T18:20:16Z","timestamp":1765650016068,"version":"3.48.0"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1991,4]]},"abstract":"<jats:p>We tested the hypothesis that the gastric H+\/K+ adenosine triphosphatase inhibitor, omeprazole, because of its different mode of action and pronounced inhibitory effect on gastric acid secretion, may be more effective in peptic ulcer that is refractory to histamine H2 receptor antagonist treatment than continuing the same therapy. Altogether 107 patients (duodenal ulcer, n = 88; prepyloric ulcer, n = 14; gastric ulcer, n = 3; mixed sites, n = 2) with refractory peptic ulcer - that is ulcer unhealed after at least two months' treatment with cimetidine 0.8 g or 1 g daily or with ranitidine 0.3 g daily - were randomly allocated to receive either omeprazole 40 mg daily (n = 54) or to continue treatment with the same H2 receptor antagonist and at the same dose (n = 53) for up to eight weeks. The patients in the two treatment groups were well matched demographically. Healing by 'intent to treat' analysis was as follows: at four weeks, omeprazole 46 of 54 (85%), H2 receptor antagonist 18 of 53 (34%) (p less than 0.0001); and at eight weeks, 52 of 54 (96%) and 30 of 53 (57%) respectively (p less than 0.0001). One patient was lost to follow up but of the 22 patients whose ulcers were shown to be unhealed at endoscopy after receiving continued H2 receptor antagonist treatment, 21 healed in four to eight weeks when changed to omeprazole. Daytime epigastric pain cleared at four weeks in 43 of 47 (91%) patients on omeprazole and in 32 of 46 (70%) on H2 receptor antagonists (p=0.01) and relief of all dyspeptic symptoms occurred in 39 of 47 (83%) and 23 of 45 (51%) (p=0.0009) patients respectively. Adverse events occurred in 11 of 54 (20%) patients on omeprazole and in 12 of 35 (34%) on cimetidine but in none on ranitidine. The events were mild and none required treatment withdrawal. The commonest event in patients on omeprazole was loose stools or diarrhoea (n=5). Omeprazole was significantly better than continued H2 receptor antagonist treatment for the short term management of refractory peptic ulcer as judged by healing rate and pain relief, and it was safe.<\/jats:p>","DOI":"10.1136\/gut.32.4.435","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"435-438","source":"Crossref","is-referenced-by-count":30,"title":["Treatment of refractory peptic ulcer with omeprazole or continued H2 receptor antagonists: a controlled clinical trial."],"prefix":"10.1136","volume":"32","author":[{"given":"K D","family":"Bardhan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Naesdal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Bianchi Porro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Petrillo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Lazzaroni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R F","family":"Hinchliffe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Morris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M J","family":"Daly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N J","family":"Carroll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1991,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1080\/00365521.1984.12005785","article-title":"The predictive value of cimetidine-induced inhibition of gastric acid secretion on the outcome of treatment in peptic ulcer disease","volume":"19","author":"Strom, M.; Bodemar, G.; Noilander, B.; Walan, A.","year":"1984","unstructured":"Strom M, Bodemar G, Noilander B, Walan A. The predictive value of cimetidine-induced inhibition of gastric acid secretion on the outcome of treatment in peptic ulcer disease. ScandJ Gastroenterol 1984; 19: 639-64.","journal-title":"ScandJ Gastroenterol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/BF01536057","article-title":"Refractory duodenal ulcers (nonhealing duodenal ulcers with standard doses of antisecretory medication)","volume":"34","author":"Collen, M.J.; Stanczak, V.J.; Ciarleglio, C.A.","year":"1989","unstructured":"Collen MJ, Stanczak VJ, Ciarleglio CA. Refractory duodenal ulcers (nonhealing duodenal ulcers with standard doses of antisecretory medication). DigDis Sci 1989; 34: 233-7.","journal-title":"DigDis Sci"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1080\/00365521.1984.12005832","article-title":"Effect of omeprazole, a substituted benzimidazole, on 24-hour intragastric acidity in patients with peptic ulcer disease","volume":"19","author":"Naesdal, J.; Bodemar, G.; Walan, A.","year":"1984","unstructured":"Naesdal J, Bodemar G, Walan A. Effect of omeprazole, a substituted benzimidazole, on 24-hour intragastric acidity in patients with peptic ulcer disease. Scand J Gastroenterol 1984; 19: 916-22.","journal-title":"Scand J Gastroenterol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1136\/gut.25.9.957","article-title":"Optimal dose of oral omeprazole for maximal 24-hour decrease in intragastric acidity","volume":"25","author":"Sharma, B.K.; Walt, R.P.; Pounder, R.E.; de FA, Gomes M.; Wood, E.C.; Logan, L.H.","year":"1984","unstructured":"Sharma BK, Walt RP, Pounder RE, Gomes M de FA, Wood EC, Logan LH. Optimal dose of oral omeprazole for maximal 24-hour decrease in intragastric acidity. 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Omeprazole in peptic ulcers resistant to histamine H2receptor antagonists. Aliment Pharmacol Therap 1987; 1: 318.","journal-title":"Aliment Pharmacol Therap"},{"key":"ref_8","first-page":"348","volume-title":"Omeprazole in the treatment of H, resistant gastro-duodenal ulcers. Gastroenterology 1988; 94","author":"Pen, J.H.; Michielsen, P.P.; Pelckhams, P.A.; Van Maercke, Y.M.","unstructured":"Pen JH, Michielsen PP, Pelckhams PA, Van Maercke YM. Omeprazole in the treatment of H, resistant gastro-duodenal ulcers. Gastroenterology 1988; 94: A348."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1136\/gut.25.7.711","article-title":"Refractory duodenal ulcer","volume":"25","author":"Bardhan, K.D.","year":"1984","unstructured":"Bardhan KD. Refractory duodenal ulcer. 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Essai therapeutique controk multicentrique","volume":"9","author":"Alexander, C.","year":"1985","unstructured":"Alexander C. Efficacite de la ranitidine et de la cimetidine dans le traitement de l'ulcere duodenal ou gastrique resistant a un traitement initial par la cimetidine. Essai therapeutique controk multicentrique. Gastroenterol Clin Biol 1985; 9: 147-152.","journal-title":"Gastroenterol Clin Biol"},{"issue":"11","key":"ref_12","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1136\/gut.28.11.1505","article-title":"Combined antimuscarinic and H2-blockade in the healing of refractory duodenal ulcer. A double-blind study","volume":"28","author":"Bardhan, K.D.; Thompson, M.; Bose, K.","year":"1987","unstructured":"Bardhan KD, Thompson M, Bose K, et al. Combined antimuscarinic and H2-blockade in the healing of refractory duodenal ulcer. A double-blind study. Gut 1987; 28(11): 1505-9.","journal-title":"Gut"},{"key":"ref_13","first-page":"126","article-title":"A combination of pirenzepine and cimetidine: a new approach to treatment of duodenal ulcer in 'nonresponders'","volume":"32","author":"PR, Dal Monte; M, D.'Imperio; M, Perrin; F, Fratucello; del Soldato P","year":"1985","unstructured":"Dal Monte PR, D'Imperio M, Perrin M, Fratucello F, del Soldato P. A combination of pirenzepine and cimetidine: a new approach to treatment of duodenal ulcer in 'nonresponders'. Hepato'gastroenterology 1985; 32: 126-6.","journal-title":"Hepato'gastroenterology"},{"key":"ref_14","first-page":"1217","article-title":"Combination of pirenzepine and cimetidine in the therapy of duodenal ulcer","volume":"82","author":"Tulassay, Z.; Papp, J.; Szathman, M.","year":"1987","unstructured":"Tulassay Z, Papp J, Szathman M. Combination of pirenzepine and cimetidine in the therapy of duodenal ulcer. 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