Peptic ulcer: antacids relieved symptoms and healed ulcers.

Clinical bottom line (level 1b)

  1. Patients with symptomatic peptic ulcers who took antacids regularly compared to placebo were more likely to have relief of symptoms (NNT = 4 at 4 weeks) and ulcer healing (NNT = 4 at 4 weeks) .
Hollander and Harlan: Journal of the American Medical Association 1973; 226 (10): 1181-1185
Expires January 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: outpatient clinic, military hospital, USA

78 patients (aged mean ~ 45 years, 68% male) with active duodenal or gastric ulceration (confirmed on upper GI radiography or endoscopy). 23% had haematemesis.

Excluded if
  • suspected pancreatic penetration
  • recurrent haematemesis
  • malignancy
  • equivocal radiography
Control Group: (n = , 31 analysed): placebo
Experimental Group: (n = , 35 analysed): antacids ( calcium carbonate ) 840 mg hourly when awake and if uncomfortable, for 4 weeks
Patients were advised to avoid ingesting milk, alcohol, caffeine and aspirin.
84% followed for 4 weeks
Outcome notes:
  • no relief of discomfort : for at least one week
  • no healing ulcer : healing ulcer: two-thirds or more reduction in size of ulceration on repeat endoscopy or upper GI radiography

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
no relief of discomfort 4 weeks 14
(38.9%)		 5
(13.5%)		 65%
(13% to 86%)		 25.4%
(6.01% to 44.7%)		 4
(2 to 17)
no healing ulcer 4 weeks 10
(32.3%)		 3
(8.57%)		 73%
(12% to 92%)		 23.7%
(4.80% to 42.6%)		 4
(2 to 21)

  • In the analysis for pain relief, there appeared to be 37 patients in the antacid group and 36 in the placebo group.

    • Citation

    1. Hollander D, and Harlan J: Antacids vs placebos in peptic ulcer therapy: a controlled double-blind investigation. Journal of the American Medical Association 1973; 226 (10): 1181-1185
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer: Martin Dawes and Horand Meier

    Clinical Question.
    Patient peptic ulcer
    Intervention or Exposure antacids
    Comparison placebo
    Outcome relief of symptoms, healing of ulcer