L E T T E R S T O T H E E D I T O R

ANTACIDS FOR GASTRIC ULCER

To The Editor: It is not surprising that Drs. Butler and Gersh (1)

should fail to find any effect of 2 hourly antacids on the healing of gastric ulcers of inpatients.

Twenty years ago, Doll and his colleagues (2) had shown that even continuous intragastric neutral- ization with alkalinized milk drip for 4 weeks had no effect on the rate of healing of gastric ulcers.

J.H. BARON, DM, FRCP Department of Surgery

Royal Postgraduate Medical School Hammersmith Hospital

London W12, England

REFERENCES

1. Butler ML, Gersh H: Antacid vs placebo in hospitalized gas- tric ulcer patients: A controlled therapeutic study. Am J Dig Dis 20:803-807, 1975

2. Doll R, Price AV, Pygott F, Sanderson PH: Continuous intra- gastric milk drip in treatment of uncomplicated gastric ulcer. Lancet 1:70-73, 1956

Response by the Author: Dr. Baron has correct ly noted that Doll (1)

showed no effect on the rate of healing of gastric ul- cers using a continuous intragastric milk drip. How- ever, no attempt was made in his study to evaluate the efficacy of antacids. In addition, Doll's control group was treated in an unspecified manner which most likely included the use of antacids. The article to which Dr. Baron refers attempts only to evaluate the possible benefit of adding milk drip to the usual therapy of antacids in ulcer disease.

MELVIN L. BUTLER, LTC, MC Chief, Gastroenterology Service

Department of the Army Letterman Army Medical Center

Presidio of San Francisco, California 94129

REFERENCES

1. Doll R, Price AV, Pygott F, Sanderson PH: Continuous intra- gastric milk drip in treatment of uncomplicated gastric ulcer. Lancet 1:70-73, 1956

METIAMIDE IN DUODENAL ULCER

To The Editor: We recently described our early clinical experience with the histamine H2-receptor antagonists metiam- ide in duodenal ulcer disease (1).

We have now followed those patients for one year. Of the i4 patients described, 5 have been oper- ated on for their ulcer disease. Of the remaining 9, 2 were asymptomatic, 3 complained of symptoms of esophageal reflux only, and 4 had experienced ul- cer-type pain, although only mild in nature.

The biochemical "screen" was repeated, and the mean values were not elevated above the day 0 val- ues in any case.

Thus, it would appear that 9 patients had relapsed during the year, but this was only confirmed in 5. Only 2 patients remained entirely symptom free.

We feel that some form of prophylaxis against ul- cer recurrence is required, once the ulcer has been healed.

M.H. THOMPSON J.D. REED

G. DALE C.W. VENABLES

REFERENCES

1. Thompson MH, Reed JD, Dale G, Venables CW: Am J Dig Dis 20:1135-1141, 1975

434 Digestive Diseases, Vol. 21, No. 5 (May 1976)