[Cimetidine versus antacids].

Abstract

The rationale of ulcer therapy with cimetidine or antacids is to block or neutralize gastric acid secretion intragastrically. 5 tablets of cimetidine can inhibit gastric acid secretion in duodenal ulcer patients by more than 50% over a 24-hour period. Approximately 250 ml per day of a highly active antacid is necessary to achieve a similar effect. The effect of cimetidine on night secretion is superior. In acute ulcer attack cimetidine brings about healing of the ulcer in duodenal ulcer disease in about 80% of all patients in about 4-6 weeks, and a maintenance dose of 200 mg in the evening may prevent a recurrence within a year in about 50% of all patients. According to American studies, antacid therapy in the above-mentioned dosage may achieve a similar healing rate in duodenal ulcer patients in acute attack. However, it is unknown whether high antacid therapy prevents ulcer recurrences. If acceptability of the treatment by the patient, side effects and costs are taken into account, cimetidine appears to be superior to high doses of antacid. However, it must be considered that in many European countries, including Switzerland, the spontaneous healing rate is up to 60% in placebo studies. It is thus legitimate to continue treating uncomplicated ulcers with the small antacid doses customary in Europe.