A Miracle Drug for Ulcer Sufferers?

George Jaggers is a high-powered executive type, founder and president of Graham Magnetics Inc., a multimillion-dollar manufacturer of magnetic computer tape. He is a passionate, driven man, easily frustrated. He has ulcers.

Jaggers, 68, is not alone in his affliction. Ulcers, which are essentially small crater-like holes in the lining of the stomach, afflict millions of Americans -roughly 17.2 percent of the population. Yet, despite their prevalence, doctors still don’t know what causes ulcers. The prime suspect, though, is acid.

Physicians know that acid irritates an ulcer and treatment of ulcers has traditionally focused on reducing the amount of acid in the stomach. To reduce stomach or gastric acid, physicians have two lines of attack: somehow to neutralize or “buffer” the acid found there-which is what antacids such as Maalox or Gelusil do-or to find some way to decrease the production of acid,which is what several types of drugs try to do.

For many years physicians prescribed a bland diet with lots of milk for an ulcer patient, thinking that milk would soothe and coat the person’s stomach. In recent years, however, in a movement led by Dr. John Fordtran, professor of internal medicine at Southwestern Medical School and one of the country’s acknowledged ulcer specialists, the belief that a bland diet is beneficial has been substantially eroded.

All foods act initially to buffer stomach acid-which is why someone with an ulcer will often find his pains disappear after a meal or a snack. So milk does have some effect. But foods also, in the process of digestion, stimulate the production of gastric acid, so that several hours after eating the levels of acid begin to rise and the ulcer patient may experience renewed pain. “What people forget,” said Dr. Walter Peterson, assistant professor of internal medicine at Southwestern, “is that milk is a protein and protein is by far the most potent stimulus of acid secretion.” The point, according to Fordtran and his fellow ulcer specialists at Southwestern, is that a bland diet with frequent milk intake is no more effective and no more speedy in healing an ulcer than a regular diet. They do advise, though, that an ulcer patient avoid aspirin, caffeine, alcohol, and any food he finds particularly irritating.

For the last 20 years whenever George Jaggers had an ulcer attack his treatment consisted of an anti-spasmodic drug taken 30 minutes before a meal to prevent his esophagus from tightening up and a dose of antacids one hour following meals and before bedtime to reduce the acid in his stomach. Jaggers would continue chugging antacids for three to six months. At $ 1.50-$3 for 12 fluid ounces-and most physicians recommend seven ounces a day – that’s $45 to $90 a month for one’s ulcer. Add to that other expenses such as visits to a physician, an upper gastro-intestinal X-ray series often used to diagnose ulcers and, occasionally, further diagnostic exams and one is talking about a $300 to $400+ a year expense. (Which doesn’t even include hospitalization, days missed from work, apprehension, inconvenience, pain, and so on.)

Even though antacids seem to work fairly well in the treatment of ulcers, they do present problems. Frequent side effects of antacid therapy are diarrhea or constipation-depending, of course, on which brand one uses. And until around 1960 liquid antacids, which are much more effective than tablets, were virtually unpalatable because of their taste. “You’d have to gag to get them down,” Jaggers remembered. “It was like swallowing chalk.”

In spite of their defects, antacids do seem to reduce stomach acid to such an extent that an ulcer may be able to heal. George Jaggers lived a relatively normal life with his ulcer erupting once or twice a year for 40 years. Until it began to bleed. Then he got scared.

He had heard of a new drug for ulcers that had been on the market in England since November and he was prepared to go there himself until he learned that he would probably not be able to get the amount he needed through customs. In addition, he dimly remembered hearing Dr. John Fordtran speak about this new drug for ulcer treatment on KERA’s “MD” show. Fordtran had called this drug “the most exciting thing that has happened in gastroenterology [the medical sub-specialty concentrating on the gastrointestinal tract] in years” and Jaggers resolved to get his help. Fordtran referred him to several colleagues who were using this drug-which is now awaiting approval by the Food and Drug Administration.

Jaggers arrived at St. Paul Hospital in mid-January and submitted to four days of tests. “The acid tests they ran showed thatmy acid levels doubled during the time when you would expect to show a very slight increase,” Jaggers said, amazed. Dr. Allen Rubin felt Jaggers was a good candidate for the drug and he gave him a tablet for the first time one evening at 10 o’clock. “I slept from 10 that evening until 7 the next morning-the greatest number of consecutive sleeping hours that I had in a year,” Jaggers said happily. “After two days of four tablets a day I had no more pain, no headache, and I’ve had none since that time. Above all, I hadn’t realized how apprehensive I was about bleeding and perforation and what a tremendous lift that was to me to have that worry removed.” Jaggers had been on the drug since mid-January and has had no further ulcer pain. “It’s nothing less than a miracle drug as far as I’m concerned,” he says.

What is this miracle drug? Cimetidine. Developed by the pharmaceutical company Smith, Kline and French after 12 years of research, cimetidine – or Tagamet as it will be known if approved for use in the U.S. – may revolutionize the treatment of ulcers. Cimetidine works to reduce gastric acid by blocking the messages that tell certain cells to produce acid. The drug snaps onto a site on the acid-making cell, much as a key fits into a lock. Once there, it prevents the chemical messenger known as histamine from delivering its message – for the cells to start releasing acid.

Cimetidine is a powerfully effective blocker. Depending on the dose it can suppress acid secretion almost totally. (Cimetidine can inhibit 75 percent of the acid normally stimulated by a meal.) Its real virtue, however, is that it is a pill.

One tablet of cimetidine could be taken with each meal and another before bedtime which is undoubtedly much easier and much more comfortable than gulping down antacids all day. After all, who wants to lug around Maalox in his hip pocket?

Cimetidine may be expensive considering Smith, Kline and French’s investment, but it may be no more expensive than a course of antacid therapy. Since its discovery several years ago, Smith, Kline and French has conducted careful clinical tests of cimetidine, first with laboratory animals and then in limited human trials. By now cimetidine has been tested with 3,000 patients, George Jaggers among them, in 27 countries. To date the drug has caused no demonstrable side effects. A team of scientists, including physicians and biochemists, at the FDA is currently considering cimetidine for approval as a new drug and most physicians feel that cimetidine will reach the market, probably as a prescription drug, within the year.