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Prostaglandin E1 Analogue Therapy in the Treatment of Refractory Gastric Ulcer in an Elderly Patient

Prostaglandin E1 Analogue Therapy in the Treatment of Refractory Gastric Ulcer in an Elderly Patient Abstract • An active 80-year-old woman without a history of peptic ulcer disease, recent nonsteroidal anti-inflammatory drug use, or smoking developed severe, symptomatic epigastric pain initially diagnosed as nonulcer dyspepsia secondary to esophagitis. Initial treatment consisted of 12 weeks of full-dose H2-receptor antagonist therapy. During this therapy the patient developed multiple gastric ulcers confirmed by endoscopy, and continued to have significant dyspeptic symptoms. An additional 16 weeks of combination therapy with ranitidine and sucralfate failed to ameliorate upper gastrointestinal symptoms, and there was significant increase in gastric ulcer size. Repeated ulcer biopsies showed no malignancy. Prior to scheduling elective gastric ulcer surgery, a trial of oral prostaglandin E1 analogue therapy was initiated with an investigational agent. Within the first three weeks of therapy, there was significant symptomatic improvement. Endoscopy of the upper gastrointestinal tract at 12 weeks revealed complete ulcer healing. This case report suggests that prostaglandin E1 analogue therapy should be considered as an alternative to elective gastric ulcer surgery for patients with refractory gastric ulcer. (Arch Intern Med 1988;148:2275-2276) References 1. National Center for Health Statistics: Vital Statistics of the United States , US Dept of Health, Education, and Welfare publication (PHS) 87-1122. Hyattsville, Md, National Center for Health Statistics, 1986, vol 2: Mortality, Part A, 1984. 2. Isenberg JI, Peterson WL, Elashoff JD, et al: Healing of benign gastric ulcer with low-dose antacid or cimetidine: A double-blind, randomized, placebo-controlled trial. N Engl J Med 1983;308:1319-1324.Crossref 3. Ryan FP: A comparison of ranitidine and placebo in the acute treatment of gastric ulcer , in The Clinical Use of Ranitidine . Oxford, England, The Medical Publishing Foundation, 1982, pp 201:205. 4. Sontag SJ: Prostaglandins in peptic ulcer disease: An overview of current status and future directions. Drugs 1986;32:445-457.Crossref 5. Newman RD, Gitlin N, Lacayo EJ, et al: Misoprostol in the treatment of duodenal ulcer refractory to H2-blocker therapy: A placebo-controlled, multicenter, double-blind, randomized trial. Am J Med 1987;83( (suppl A) ):27-31.Crossref 6. Barry PP: Primary care evaluation of the elderly for elective surgery. Geriatrics 1987;42:77-85. 7. Mullersman G, Gotz VP, Russell WL, et al: Lack of clinically significant in vitro and in vivo interactions between ranitidine and sucralfate. J Pharm Sci 1986;75:995-998.Crossref 8. Albin H, Vincon G, Lalague MC, et al: Effect of sucralfate on the bioavailability of cimetidine. Eur J Clin Pharmacol 1986;30:493-494.Crossref 9. D'Angio R, Mayersohn M, Conrad KA, et al: Cimetidine absorption in humans during sucralfate coadministration. Br J Clin Pharmacol 1986;21:515-520. 10. Van Deventer GM, Schneidman D, Walsh J: Sucralfate and cimetidine as single agents and in combination for treatment of active duodenal ulcers: A double-blind, placebo-controlled trial. Am J Med 1985;79( (suppl) ):39-44.Crossref 11. Lacz JP, Dress DT, Browne R: Sucralfate binding in cimetidine treated rats. Gastroenterology 1983;84:1220. 12. Allison AC, Kowalski JW, Strulovici B: Effects of enprostil on platelets, endothelial cells, and other cell types, and second messenger systems by which these effects are mediated. Am J Med 1986;81( (suppl) ):34-39.Crossref 13. Tsai BS, Kessler LK, Schoenhard G, et al: Demonstration of specific E-type prostaglandin receptors using enriched preparations of canine parietal cells and (3H)misoprostol free acid. Am J Med 1987;83( (suppl) ):9-14.Crossref 14. Tepperman BL, Duncan JA, Barr DB, et al: Specific binding, endogenous levels and biological action of prostaglandin E2 and prostacyclin in enriched fractions of duodenal ulcer: A multicenter double-blind controlled trial. Dig Dis Sci 1986;31( (suppl) ):63-67.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Prostaglandin E1 Analogue Therapy in the Treatment of Refractory Gastric Ulcer in an Elderly Patient

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380100119025
Publisher site
See Article on Publisher Site

Abstract

Abstract • An active 80-year-old woman without a history of peptic ulcer disease, recent nonsteroidal anti-inflammatory drug use, or smoking developed severe, symptomatic epigastric pain initially diagnosed as nonulcer dyspepsia secondary to esophagitis. Initial treatment consisted of 12 weeks of full-dose H2-receptor antagonist therapy. During this therapy the patient developed multiple gastric ulcers confirmed by endoscopy, and continued to have significant dyspeptic symptoms. An additional 16 weeks of combination therapy with ranitidine and sucralfate failed to ameliorate upper gastrointestinal symptoms, and there was significant increase in gastric ulcer size. Repeated ulcer biopsies showed no malignancy. Prior to scheduling elective gastric ulcer surgery, a trial of oral prostaglandin E1 analogue therapy was initiated with an investigational agent. Within the first three weeks of therapy, there was significant symptomatic improvement. Endoscopy of the upper gastrointestinal tract at 12 weeks revealed complete ulcer healing. This case report suggests that prostaglandin E1 analogue therapy should be considered as an alternative to elective gastric ulcer surgery for patients with refractory gastric ulcer. (Arch Intern Med 1988;148:2275-2276) References 1. National Center for Health Statistics: Vital Statistics of the United States , US Dept of Health, Education, and Welfare publication (PHS) 87-1122. Hyattsville, Md, National Center for Health Statistics, 1986, vol 2: Mortality, Part A, 1984. 2. Isenberg JI, Peterson WL, Elashoff JD, et al: Healing of benign gastric ulcer with low-dose antacid or cimetidine: A double-blind, randomized, placebo-controlled trial. N Engl J Med 1983;308:1319-1324.Crossref 3. Ryan FP: A comparison of ranitidine and placebo in the acute treatment of gastric ulcer , in The Clinical Use of Ranitidine . Oxford, England, The Medical Publishing Foundation, 1982, pp 201:205. 4. Sontag SJ: Prostaglandins in peptic ulcer disease: An overview of current status and future directions. Drugs 1986;32:445-457.Crossref 5. Newman RD, Gitlin N, Lacayo EJ, et al: Misoprostol in the treatment of duodenal ulcer refractory to H2-blocker therapy: A placebo-controlled, multicenter, double-blind, randomized trial. Am J Med 1987;83( (suppl A) ):27-31.Crossref 6. Barry PP: Primary care evaluation of the elderly for elective surgery. Geriatrics 1987;42:77-85. 7. Mullersman G, Gotz VP, Russell WL, et al: Lack of clinically significant in vitro and in vivo interactions between ranitidine and sucralfate. J Pharm Sci 1986;75:995-998.Crossref 8. Albin H, Vincon G, Lalague MC, et al: Effect of sucralfate on the bioavailability of cimetidine. Eur J Clin Pharmacol 1986;30:493-494.Crossref 9. D'Angio R, Mayersohn M, Conrad KA, et al: Cimetidine absorption in humans during sucralfate coadministration. Br J Clin Pharmacol 1986;21:515-520. 10. Van Deventer GM, Schneidman D, Walsh J: Sucralfate and cimetidine as single agents and in combination for treatment of active duodenal ulcers: A double-blind, placebo-controlled trial. Am J Med 1985;79( (suppl) ):39-44.Crossref 11. Lacz JP, Dress DT, Browne R: Sucralfate binding in cimetidine treated rats. Gastroenterology 1983;84:1220. 12. Allison AC, Kowalski JW, Strulovici B: Effects of enprostil on platelets, endothelial cells, and other cell types, and second messenger systems by which these effects are mediated. Am J Med 1986;81( (suppl) ):34-39.Crossref 13. Tsai BS, Kessler LK, Schoenhard G, et al: Demonstration of specific E-type prostaglandin receptors using enriched preparations of canine parietal cells and (3H)misoprostol free acid. Am J Med 1987;83( (suppl) ):9-14.Crossref 14. Tepperman BL, Duncan JA, Barr DB, et al: Specific binding, endogenous levels and biological action of prostaglandin E2 and prostacyclin in enriched fractions of duodenal ulcer: A multicenter double-blind controlled trial. Dig Dis Sci 1986;31( (suppl) ):63-67.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1988

References