[Long-term prevention with H2 receptor antagonists. An effective concept for treating ulcer disease]

Chronic duodenal or gastric ulcer is a relapsing disease. Therefore, in many cases a long-term treatment strategy is required to prevent painful recurrences. As the recurrence rate as well as the rate of complications can be reduced to a high extent by a single nocturnal dosage, histamine-(H2)-receptor antagonists can be regarded as the drugs of the first choice. They have a very low rate of severe side-effects, especially those which were released more recently like ranitidine or famotidine. Frequently the healing of break-through-ulcers (which may occur under a long-term medication) can be achieved by doubling the dosage for a few weeks. Many reports recommend a maintenance treatment with H2-receptor antagonists for a period of two years. Only ulcer patients with frequent relapses should be treated either continuously for longer periods or surgical treatment (proximal gastric vagotomy, partial gastrectomy) should be considered. Complications which can not be managed conservatively or initial non-responders should also lead to surgical procedures.