Failure of potent antacid therapy to hasten healing in chronic gastric ulcers

Cultural variations in the placebo effect: ulcers, anxiety, and blood pressure

An analysis of the control groups in double-blind trials of medicines demonstrates broad variation--from 0 to 100 percent--in placebo effectiveness rates for the same treatment for the same condition. In two cases considered here, drug healing rates covary with placebo healing rates; placebo healing is the ultimate and inescapable "complementary medicine." Several factors can account for the dramatic variation in placebo healing rates, including cultural ones. But because variation differs by illness, large placebo effects for one condition do not necessarily anticipate large placebo effects for other conditions as well. Deeper understanding of the intimate relationship between cultural and biological processes will require close ethnographic scrutiny of the meaningfulness of medical treatment in different societies.

Antacids: the past, the present, and the future

Antacids have served us well for over a century. The attitude in the late 1950s to 1970s that antacids should be taken only on demand was unjustified and was based on what can be seen nowadays as misinterpretation of scientific data. Twelve recent endoscopic controlled studies have confirmed the efficacy of antacids in the healing of duodenal ulcer, achieving about 75% healing in 4 weeks. Like H2-receptor antagonists, the efficacy of antacids in the healing of gastric ulcers is controversial, most probably related to the even greater pathogenetic heterogeneity of this condition. Antacids should be given at least four times a day and at least 1 hour after meals, since their therapeutic success most likely depends on neutralization of postprandial acid secretion. In vivo, the newer tablet forms are indistinguishable from the liquid forms in terms of neutralizing efficiency and healing efficacy. The ideal dose is one that neutralizes 400 mmol of acid. Combination with an anticholinergic drug is effective and a recent report suggests that this may lead to longer remission than with H2-receptor antagonists. As a long-term therapy, antacids appear to work but need to be taken in multiple daily doses, a regimen which is unlikely to meet with long-term patient compliance. The success of antacids in duodenal ulcer healing should alert us to the importance of controlling the meal-stimulated acid secretion in ulcer therapy, and to the hard fact that acid is a non-permissive factor in ulcer healing.

The effect of tri-potassium di-citrato bismuthate (De-Nol) on the healing of chronic duodenal ulcers

Forty-six patients suffering from chronic duodenal ulcer, proven endoscopically, were treated in a randomized double-blind cross-over trial with either tri-potassium di-citrato bismuthate (De-Nol) or placebo for four weeks and assessed symptomatically and endoscopically. Those patients who failed to heal after treatment with either agent were crossed over to the alternative preparation and reassessed after a further 28 days. Forty-two patients completed the study involving 57 patient treatments. A highly significant improvement in both symptomatic response (P less than 0.01) and endoscopic healing (P less than 0.01) was seen in those patients receiving tri-potassium di-citrato bismuthate (De-Nol) as against placebo therapy.

The healing of gastric ulcers by zinc sulphate

A double-blind trial of zinc sulphate given by mouth (220 mg, three times a day) and placebo was undertaken in patients with benign gastric ulcers. The drug was given for a three-week period and the healing of the ulcers was estimated from results of barium-meal X-ray films taken immediately before and after this period. There were ten patients taking zinc sulphate and eight patients taking placebo. The two groups of patients were comparable in all respects, including initial ulcer size. Patients taking zinc sulphate had an ulcer healing rate three times that of patients treated with placebo. This difference was significant (P less than 0-05). Complete healing of ulcers occurred more frequently in the patients taking zinc sulphate than in patients treated with placebo. The placebo group contained more patients whose ulcers did not heal at all, than the group taking zinc sulphate. No side effects from zinc sulphate were noted. There was no evidence of zinc deficiency in any of the patients.

Antacid vs placebo in hospitalized gastric ulcer patients: a controlled therapeutic study

Antacids are widely accepted as agents that promote healing and relieve pain of gastric ulcer. Well-controlled studies designed to test this belief are few. 28 patients with endoscopically proven gastric ulcer were treated for 3 weeks in hospital, 13 receiving a liquid placebo and 15 an antacid. All were followed by endoscopy to complete healing or until surgery was performed. 10 patients healed satisfactorily in the placebo group and 11 in the antacid group. All patients were free of pain during their hospitalization. From this study it is concluded that in gastric ulcer patients hospitalized for 3 weeks, the rate of healing of the ulcer and the relief of pain is not influenced by treatment with a standard antacid preparation.