76361
document
Sucralfate overcomes adverse effect of cigarette smoking on duodenal ulcer healing and prolongs subsequent remission . A unicenter , single-blind , randomized study was conducted on 283 patients with active duodenal ulcer to compare possible factors that may affect healing and relapse in patients treated with a potent antisecretory agent , cimetidine , or a site-protective and cytoprotective agent , sucralfate . The endoscopic healing rates at 4 wk were 76 % and 79 % , respectively , and cross-over treatment of the failures for a further 4 wk resulted in 68 % healing with cimetidine and 69 % healing with sucralfate , both differences being not statistically different . Unlike cimetidine , healing by sucralfate was unaffected by cigarette smoking , reluctance to give up smoking , habitual use of alcohol , high maximal acid output , and large ulcer diameter . In particular , the healing rate of smokers treated with sucralfate ( 82 % ) was significantly greater than that of smokers treated with cimetidine ( 63 % ) . Duodenal bulb deformity significantly affected healing in both groups , and was the only offsetting factor identifiable for sucralfate out of 46 factors examined . Of the patients with healed ulcers , 238 participated in a 24-mo follow-up study consisting of interviews at 2-mo intervals and endoscopy at 4-mo intervals or whenever symptoms recurred . The cumulative relapse rate was significantly ( p less than 0.007 ) greater in patients healed with cimetidine than with sucralfate , 50 % relapse occurring at 6 and 12 mo , respectively . In both , the cumulative relapse rate was significantly greater in cigarette smokers than in nonsmokers , but smokers and nonsmokers treated with cimetidine relapsed ( 50 % at 4 and 8 mo , respectively ) faster than the corresponding smokers and nonsmokers treated with sucralfate ( 50 % at 8 and 18 mo , respectively ) . Furthermore , in cimetidine- but not sucralfate-healed patients , early ulcer relapse ( within 6 mo ) was associated with short duration of illness , short remission period , long symptomatic spell , and reluctance to give up smoking . We conclude that smoking adversely affects duodenal ulcer healing by cimetidine and hastens subsequent relapse , and that sucralfate overcomes the adverse effect of smoking on healing as encountered with cimetidine , and results in a subsequent remission period double that of cimetidine .
76362
Intervention_Pharmacological
Sucralfate
76363
Intervention_Pharmacological
antisecretory agent
76364
Intervention_Pharmacological
cimetidine
76365
Intervention_Pharmacological
sucralfate
76366
Intervention_Pharmacological
cimetidine
76367
Intervention_Pharmacological
sucralfate
76368
Intervention_Pharmacological
cimetidine
76369
Intervention_Pharmacological
sucralfate
76370
Intervention_Pharmacological
sucralfate
76371
Intervention_Pharmacological
cimetidine
76372
Intervention_Pharmacological
sucralfate
76373
Intervention_Pharmacological
cimetidine
76374
Intervention_Pharmacological
sucralfate
76375
Intervention_Pharmacological
cimetidine
76376
Intervention_Pharmacological
sucralfate
76377
Intervention_Pharmacological
cimetidine-
76378
Intervention_Pharmacological
sucralfate-healed
76379
Intervention_Pharmacological
cimetidine
76380
Intervention_Pharmacological
sucralfate
76381
Intervention_Pharmacological
cimetidine
76382
Intervention_Pharmacological
cimetidine
76383
Outcome_Physical
ulcer healing
76384
Outcome_Physical
endoscopic healing rates
76385
Outcome_Physical
healing rate
76386
Outcome_Physical
cumulative relapse rate
76387
Outcome_Physical
cumulative relapse rate
76388
Outcome_Physical
relapsed
76389
Outcome_Other
duration of illness
76390
Outcome_Physical
remission period
76391
Outcome_Physical
long symptomatic spell
76392
Outcome_Physical
reluctance to give up smoking
76393
Participant_Condition
duodenal ulcer
76394
Participant_Sample-size
283
76395
Participant_Condition
duodenal ulcer
76396
Participant_Condition
antisecretory agent , cimetidine ,
76397
Participant_Condition
site-protective and cytoprotective agent
76398
Participant_Condition
ulcers
76399
Participant_Sample-size
238