Progress in Patients with Peptic Ulceration Treated for more than Five Years with Poldine, including a Double-blind Study

Abstract

The beneficial effect of vagotomy in patients with duodenal ulc?ration is believed to depend on the halving of the gastric secretion of acid which follows the operation, and which persists for at least three years (Bell, 1964). It would be advantageous if a similar reduction in secretion could be produced by blocking the action of the vagus nerves pharmacologically?for example, with an anticholinergic compound?without the occasional ill effects of surgical vagotomy. However, the orthodox view is that the anticholinergic drugs do not reduce the acidity of the gastric contents in patients taking food, and their only real value is as antispasmodics {B.M.J., 1963). The heterodox view is that atropine, and poldine methylsulphate (Nacton), as examples of drugs with tertiary and quaternary nitrogen, in doses which produce no side-effects, do inhibit gastric secretion of acid in response to food (Mitchell, Hunt, and Grossman, 1962). An average reduction of the gastric secretion of acid by one half in a group of outpatients with peptic ulc?ration treated with poldine was reported four years ago (Douthwaite, Hills, and Hunt, 1961). Before this treatment they had been losing an average of 28 days' work a year, and had needed treatment in hospital at the beginning of the trial. During treatment they lost an average of only two days' work a year. However, it was not established that the improved clinical course resulted from a reduction in the gastric secretion of acid, since the patients were receiving monthly test meals and extra clinical interest. It was therefore decided to treat them under double-blind condi tions. The present paper contains an account of the results and difficulties met with in so doing.