Abstract

A two phase study was performed to identify factors that influence the healing rate of duodenal ulcer. The study included an initial clinical trial in 145 patients and a second trial in a further 61 patients. All patients were prescribed cimetidine at a daily dose of 800 mg for six weeks. The factors examined were age, sex, inpatient or outpatient treatment, duration of present ulcer pain, past history of duodenal ulcer, smoking, drinking, the length of time it took for symptoms to resolve after beginning treatment, and the characteristics of the ulcers themselves. Eighty four per cent of the duodenal ulcers healed after six weeks. Using univariate and multivariate analyses, it was found that three factors indicated a significant delaying effect on healing: (1) symptoms that persisted two weeks after treatment had begun; (2) heavy smoking (20 or more cigarettes daily); and (3) severe narrowing of the duodenal bulb. Patients with none of the three unfavourable factors (n = 90) had a healing rate of 95.6% compared with patients with one (n = 45) or two or more (n = 10) factors, whose healing rates were 75.6% and 20.0% respectively (p less than 0.001). The corresponding figures in a second study were 88.9%, 55.0%, and 0%, respectively (p less than 0.001). A prognostic score based on these three factors represents the severity of duodenal ulcers with regard to healing in patients treated with cimetidine.