The Use of Hydrated Magnesium Trisilicate in Peptic Ulcer (Preliminary Repo,t)

By

MANFRED KRAEMER, M.D., F.A.C.P.$ NEWARK, NEW JERSEY

H YDRATED Magnesium Trisilicate was introduced into therapeutics in 1936 by N. Mutch (1, 2, 3).

The first to write about the subject in the American literature was Levin (4). He used the trisilicate of Magnesiu m in a mixture with other antacids to treat peptic ulceration. Hurst (5) is the only other author who has referred to the clinical use of this substance.

Because, according to Mutch, the antacid power of Hydrated Magnesium Trisilicate is sustained for hours even in the presence of excess of acid, because its ad- sorbtive power lasts even for a few days, because it has strong antipeptic powers, because even in large doses it causes neither constipation nor diarrhea, and because it cannot produce alkalosis by absorption of unused excess, I considered this an ideal antacid for use in patients with peptic ulcer. All antacid powders have certain definite d r a w b a c k s - - t h e constipation caused by Bismuth and Calcium Salts, the laxation of Magnesia, the secondary rise and tendency to alkalosis caused by Sodium Bicarbonate are well known. For the past two years I have used Colloidal Aluminum Hydroxide preparations with good results and with- out some of the ill effects expressed above except for very frequent complaints of constipation and two cases of fecal impaction.

In view of the marked relief of symptoms obtained in peptic ulceration with the use of Magnesium Trisili- cate I am presenting this preliminary report to stimu- late fur ther clinical trial of the powder. My results have been so grat i fying that I am replacing other alkalis with this preparation.

I have now used Hydrated Magnesium Trisilicate in 38 private patients having roentgenologically proven w ulcers associated with definite hyperacidity to a test meal, and typical symptoms. The preparation has also been used on several clinic patients fulfilling the same criteria. Due to insufficient time for follow up on the clinic cases I am not including them in this preliminary report. The drug has been used by the patients for from three to six months. The patients were all kept on an ambulant diet. A few had a pre- liminary rest period at home of from three days to two weeks. In general the routine was the same as I have used for some time except for the substitution of the Hydrated Magnesium Trisilicate in place of other

*From the Gastro-Enterological Clinic of the Presbyterian Hospital in Newark.

'~A supply of Hydrated Magnesium Trisilicate Powder was kindly supplied to the Clinic by Frederick Stearns and Company. That used by the private patients was purchased on prescription.

$Chief, Gastro-Enterologlcal Clinic, Presbyterian Hospital. Gastro- Enterologist, St. James Hospital in Neavark.

w wri t ing of article, the powder has been used on 2 cases of gastric ulcer with resulting disappearance of the niche on X-ray.

Submitted February 1, 1938.

422

antacids. The patients received three light meals per day and a glass of milk or milkshake or tea between meals and in the evening. One hour af ter meals and one hour after the between meal feedings and at bed- time they were given a teaspoonful of the powder. Some bromide or phenobarbital was given if ~;here was excessive nervousness or sleeplessness. Some of the patients also received tincture of belladonna. I f there was night pain the patients set their alarm clocks one hour before the anticipated period of dis- tress and took a teaspoonful of the powder at that time. Some of the patients had had ulcer symptom recurrences for many years and had had many types of treatment. Two of the patients had had a gastro- enterostomy for ulcer with recurrence of symptoms but without demonstrable jejunal ulcer. One had been doing well on Colloidal Aluminum Hydroxide but com- plained of constipation. On changing to the ]~Iag- nesium Trisilicate he continued to do well and no longer was constipated.

All the patients in this group are improved. Of course, this is the usual response to any new therapy. However, to control psychic factors, the patients were not told that they were receiving a new preparation. I do not hold Magnesium Trisilicate to be a cure for peptic ulceration but merely as a valuable antacid. Antacids are used not to cure ulcers but to control symptoms. The cure of ulcer is a problem of changing the patient's mode of living, thought process and dietary habits so that the factors producing recur- rences will not come into play. Of prime significance in the use of this powder is the fact that not a single patient complained that it affected his bowel habits in any way. None of the patients showed symptoms of alkalosis. Hurst (5) has given this preparation in 30 grain doses to ulcer patients and alkalosis has never developed.

I am not presenting a statistical table in this pre- liminary report. The time the patients have been under treatment is too short and the number of cases is too few for use of any statistical method of evalu- ating the powder. In my clinical judgment, this is a valuable therapeutic agent which merits fur ther trial.

R E F E R E N C E S I. Mutch, N. : The Silicates of Magnesium. Br. Med. Jr,, 3916:143-

148, Jan . 25, 1936. 2. Mutch, N. : Synthetic Magnesium Trisilicate. Br. Med. Jr., 3917:

205-208, Feb. 1, 1936. 3. Mutch, N. : Hydrated Magnesium Trisilicate in Peptic Ulcera~ion.

Br. Med. Jr., 3918:254-257, Feb. 8, 1936. 4. Levin, M. B.: Peptic Ulcer Therapy. Am. Jr. Dig. Dis. and

Nutrlt., 4:574-576, Nov., 1937. 5. Hurst , Ar thur F. : Diseases of the Alimentary Canal. The Pn~ctl-

tioner, Special Number, 137:409-422, Oct., 1936.