A 24-year-old woman develops epigastric pain and has a diagnosis of duodenal ulcer confirmed by esophagogastroduodenoscopy. The patient is in the third month of a pregnancy. The most appropriate treatment would be:

c. Sucralfate 1 gm q.i.d.

Cimetidine, ranitidine, famotidine and newer H2 receptor antagonists bind competitively to parietal cell histamine receptors to produce reversible inhibition of acid secretion. While the pharmacokinetic profiles of the H2 receptor antagonists differ, when administered at equipotent doses, the agents produce similar degrees of acid suppression and similar rates of ulcer healing. Cimetidine interacts with the hepatic microsomal enzyme system and may increase blood levels and pharmacological effects of drugs that depend upon hepatic metabolism. Misoprostol, a derivative of prostaglandin E, causes endoscopic healing in 60% of patients at 4 weeks. The major side effect of misoprostol is diarrhea due to effects upon gut smooth muscle contractility. Uterine bleeding has been reported in some women using the drug and the agent has potential abortifacient actions. For this reason, misoprostol is contraindicated in pregnancy. Sucralfate, the aluminum salt of sulfated sucrose, has virtually no systemic absorption, and for this reason, is the drug of choice for pregnant patients. When administered at a dose of 1 gm four times daily, 80% of ulcers will heal by 6 weeks.