Abstract
The presence of endoscopic signs of recent haemorrhage (SRH) greatly increases the risk of rebleeding from peptic ulcers. Fifty-five patients with acute bleeding from chronic duodenal ulcers with SRH completed a randomized double-blind trial to assess the effect of administration of Cimetidine (800 mg daily intravenously for 2 days, then 1000 mg daily orally for 10 days in divided doses) versus placebo on rebleeding and need for emergency surgery. In the Cimetidine group (n = 29), 5 rebled, compared with 11 receiving placebo (n = 26) (p > 0.05; relative risk, 0.28, 95% confidence interval, 0.08-0.97). This reduction in rebleeding rate in the cimetidine-treated patients was observed only in subjects over 60 years of age. Fifteen patients receiving Cimetidine required blood transfusion (mean. 2.3 ± 0.6 (SEM) units per patient) compared with 19 receiving placebo (3.5 ± 0.5) (p > 0.1). Emergency surgery to arrest bleeding was required in three patients receiving Cimetidine and four receiving placebo (p > 0.5). Cimetidine therapy should be considered in patients more than 60 years old who present with haemorrhage from a chronic duodenal ulcer with SRH and who arc at high risk of rebleeding.
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