[H2-blocker refractory ulcers: what can be done?].

H2-receptor antagonist refractory ulcers are seldom. Less than 5% of duodenal ulcers do not heal under H2-blockers. Today it is more and more accepted that duodenal ulcer is only H2-receptor antagonist refractory after a consequent therapy with H2-receptor antagonists in a standard dose or high doses for at least 2-3 months. The aims of therapy is refractory ulcers include as in non-refractory ulcers healing, pain relief and relapse prophylaxis. Often there is the choice to switch to a more potent antisecretory drug. E.g. ranitidine 300 mg/die was administered successfully in so-called cimetidine resistant ulcers. The specific acid inhibitory profile of omeprazole characterises this substance as a promising alternative in the treatment of H2-receptor antagonist refractory ulcers. In a large controlled clinical therapeutic trial with omeprazole 20 mg/die versus ranitidine 300 mg/die, however, no significant differences were observed in the 2- and 4-weeks healing rates. In two further controlled studies including 99 and 50 patients respectively treated with omeprazole 40 mg/die or cimetidine 800 mg/die and ranitidine 300 mg/die significantly higher healing rates were observed in favour of omeprazole. H2-blocker resistant ulcers are characterised by frequent and rapidly developing relapses. In this cases further treatment with H2-blockers in a two- or threefold daily dose has proved to be effective treatment. The administration of high omeprazole doses (40-60 mg/die) has also produced very convincing clinical results. If the above mentioned therapeutic measure do no provide adequate therapeutic results surgical procedures--usually resection--are indicated.