Urinary excretion of steroid hormone metabolites in men with duodenal ulcer

Duodenal ulcer is more common and usually more severe in men than in women. One hypothesis put forward to explain this sex difference is that men undergo more stress than women. Therefore, the urinary excretion of androsterone (A), aetiocholanolone (E) and 17-hydroxycorticoids has been determined in 25 normal men, and 22 hospital controls and 35 patients with duodenal ulcer (D.U.) before and after surgery. The excretion of steroids was the same in the normal controls arid the preoperative controls and D.U. patients. After surgery the controls showed a significant decrease in E excretion, and the D.U. patients had a decrease in excretion of E large enough to raise the A/E ratio. The results are not consistent with the view that endogenous androgenic or adrenocortical steroids maintain D.U.     

Intermittent treatment of duodenal ulcer with cimetidine.

Intermittent treatment with short courses of cimetidine given only when symptoms recurred was assessed in patients with duodenal ulcer as an alternative to maintenance treatment. Their progress was followed up for up to 22 months. Gastroscopy was carried out in most attacks to confirm recurrence of the ulcer and subsequent healing. Out of 125 patients treated, 83 relapsed, of whom 21 defaulted. After retreatment 36 patients relapsed again. The pattern of relapse and remission for the group as a whole was similar after both courses of treatment, indicating an unchanged natural history. Nevertheless, wide variation occurred in individual patients, so that the pattern of relapse could not be predicted by the duration of the initial remission. Most patients had one or two or rarely three symptomatic relapses a year, which were rapidly treated successfully with cimetidine. Therefore, unless the necessity for long-term maintenance treatment is established, intermittent treatment provides an adequate alternative in most patients with duodenal ulcer.     

Late mortality after vagotomy and drainage for duodenal ulcer.

Seven hundred and thirty five patients who underwent elective vagotomy and drainage procedures in one hospital during 1957-67 were followed up until 1 September 1982. At this time 281 were dead compared with an expected 184. This gives a ratio of observed to expected deaths of 1.53 (p less than 0.0001). The most important cause of increased mortality was lung cancer, which accounted for 33 of the excess deaths (observed to expected ratio 3.53). Gastric cancer yielded an observed to expected ratio of 3.3. Other causes of death that were significantly more common than expected were cerebrovascular accident, bronchopneumonia, and colorectal cancer. It is concluded that although gastric cancer occurs more commonly after vagotomy and drainage than in the general population, it is not as important a cause of death as diseases related to smoking.