Prevention and management of relapse of peptic ulcer [review, tutorial]

The dictum, "Once an ulcer, always an ulcer" is most likely true, because recent evidence suggests that peptic ulcers do not burn out. In fact, ulcer relapse and with it the potential complications become the major concern in the management of this condition. Prevention and treatment of a disease depends on the understanding of its aetiology. For peptic ulcer, however, therapeutic advances have outpaced scientific attempts to understand its cause. Even though clinicians have been therapeutically successful, there is no clear answer to the fundamental question as to why ulcers in general heal with the known therapeutic agents including H2-receptor antagonists, antacids, proton pump inhibitors, anticholinergics, site-protective agents, and cytoprotective agents. This review examines this question while at the same time outlining the present day understanding of the prevention and treatment of peptic ulcer relapse.