Peptic ulcer: persisting symptoms and large ulcers increased the risk of not healing

Clinical bottom line (level 2b)

  1. A quarter of elderly patients with peptic ulcers failed to heal after 8 weeks of ranitidine.
  2. Patients with persisting symptoms or large duodenal ulcers were at increased risk of not healing.
Battaglia et al: Digestive Diseases and Sciences 1993; 38 (8): 1414-1421
Expires October 2002

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 37 acute hospitals, Italy

1052 patients (aged > 65, 57% male) with endoscopically-proven active peptic ulcer

Excluded if
  • aged < 65
  • gastric cancer
  • predictable low compliance
  • previous major GI surgery
  • 2 ulcers in the same area
  • bleeding ulcers
  • severe pyloric stenosis
  • ulcer perforation
  • severe concomitant diseases

Factors studied:

  • age, sex, smoking, previous complications, alcohol consumption, family history, NSAID use, symptoms

All patients received ranitidine 150 mg or 300 mg by mouth daily.

Multivariate regression analysis performed on risk factors.

91% followed for 8 weeks
Outcomes studied:

  • failure to heal on repeat endoscopy

 

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
failure to heal 8 weeks 227/959 24%
(21% to 26%)		 4
(4 to 5)

  • The following risk factors were found to be independently associated with slow healing:
    • persisting ulcer symptoms
    • duodenal ulcer diameter larger than 20 mm

Comments

  1. The data comes from a randomised controlled study comparing different doses of ranitidine.
  2. Odds ratios were not reported.
  3. The lack of H. pylori testing may invalidate these results

Citation

  1. Battaglia G, di Mario F, Dotto P, et al: markers of slow-healing peptic ulcer in the elderly: a study of 1052 ranitidine-treated patients. Digestive Diseases and Sciences 1993; 38 (8): 1414-1421
Contributor: Chris Ball and Bob Phillips, October 1999
Reviewer: Goutham Rao

Clinical Question.
    Patient peptic ulcer
    Intervention or Exposure clinical factors
    Outcome ulcer healing