Blind Trial of a Degraded Carrageenin and Aluminium Hydroxide Gel in the Treatment of Peptic Ulceration.

MUCH experimental work and a few clinical studies have been devoted to the anti-ulcer properties of sulphated polysaccharides (Babkin and Komarov, 1932; Schiffrin and Warren, 1942; Wolf and Wolff, 1943; Watt, 1959). Ebimar (Evans Medical Ltd.) is such a substance derived from seaweed (Chondrus Crispus or Gigartina Stellata). Ebimar is based on carrageenan, a sulphated polygalactose. It is produced by depolymerising a crude extract of carrageenan, using phosphoric acid and hydrogen peroxide. This reduces the molecular weight of carrageenin from 100,000-700,000 to about 20,000. By this process viscosity and gel formation are greatly reduced, making it easier to administer to patients. It is thought that ebimar consists largely of lambda-carrageenan and it has a sulphate content of 31% (Personal communication from Evans Medical Ltd.). Ebimar has been shown to combine with protein substrate and protects the substrate from peptic digestion. Gastric mucus, protein foods and the protein on an ulcer floor are acted upon in this manner (Anderson and Watt, 1959a, b, c; Bonfils, Dubrasquet and Lambling, 1959, 1960; Houck, Bhayana and Lee, 1960; Bonfils and Lambling, 1960a). Watt and Marcus (in preparation), using a metachromatic stain, demonstrated that after oral administration of ebimar, prior to gastrectomy in humans, the substance was found in strands of mucus adherent to the gastric mucosa. Acid facilitates the formation of this complex, which has pepsin-inhibiting properties. In uncontrolled clinical trials of ebimar, Bonfils and Lambling (1960b) treated 32 peptic ulcer patients who had failed to respond to other medicinal therapy. They were impressed with the results and so were Lambling, Bonfils, Kaess and Simonpoli (1960), who followed patients for up to 18 months. Both these papers emphasise the importance of dosage and the frequency of administration of the substance. Berthet (1961), Esposito (1962) and de Landazuri, Badell and Badell and Conchillo (1961) also reported favourably on ebimar. The latter advocate sucking the tablets. Esposito and Nicolini (1961) showed that in patients with a raised blood pepsinogen ebimar caused a return towards normal levels. In 1959 we started a double blind trial of ebimar and aluminium hydroxide gel in the treatment of peptic ulceration.