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August 1, 1977

Medical News

JAMA. 1977;238(5):379-387. doi:10.1001/jama.1977.03280050011002

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Endoscopy shows that when pain stops, ulcers may linger on  The absence of symptoms can be an unreliable indicator of the status of a duodenal ulcer.Before the availability of endoscopy, relief of symptoms was considered the best available criterion for judging efficacy of treatment. But the results of two recent independent studies of ulcer treatments show that the amelioration of pain does not always correlate with improvement of the ulcer.In one study, 16 of 49 duodenal ulcer patients who were totally symptom-free after four weeks of treatment still had unhealed ulcers as seen by endoscopy. In nine, the ulcer was the same size or larger than it had been a month earlier.This surprising result surfaced from a double-blind multicenter study of the effect on duodenal ulcer healing and symptom relief of large doses of liquid antacid—a treatment whose efficacy is still contested despite widespread acceptance.The