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The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

Upper gastro-intestinal bleeding or other complications after operations on this tract can lead to grave additional risk for the patient, especially in the early postoperative phase. Because of its high degree of diagnostic accuracy, emergency endoscopy is in most cases of decisive importance in planning the type (conservative or surgical) and timing of any necessary treatment. Special investigative techniques as well as the early use of endoscopy in 97 patients achieved a high rate of success at a low risk to the patients. Indications, results and risks of emergency endoscopy of the upper gastro-intestinal tract in the late postoperative phase are similar to those for the non-operated patient.