IS IT “NO ACID, NO ULCER” OR “YES ACID, WORSE ULCER?”

Collen et al. studied the healing of bleeding and nonbleeding duodenal ulcers with respect to gastric acid secretion. There were 110 patients with endoscopically documented ulcer disease, 38 of whom had endoscopic evidence of active or recent bleeding (visible vessel, fresh clot, active oozing, or pigmented spots). Sixteen of 38 bleeding ulcers received endoscopic therapy. The authors reported a higher mean basal acid output in patients with bleeding or stigmata of recent hemorrhage. All patients underwent repeat endoscopy after an 8‐wk course of standard H2‐receptor antagonist therapy. Eighty percent of ulcers had healed. Of interest, 14 of the 38 bleeding ulcers had not healed. Nine of these ulcers had received endoscopic therapy. All patients with bleeding and nonbleeding unhealed ulcers were gastric acid hypersecretors (>10 mEq/h). The patients with unhealed ulcers were further evaluated with serial gastric acid measurements prior to an increased H2‐receptor antagonist dose, to titrate doses to an acid output of < 10 mEq/h. Once this was accomplished, the patients embarked upon another 8‐wk course of therapy with follow‐up endoscopy. All of the 28 initially nonhealing ulcers healed.