Recent advances in the treatment of digestive diseases

Significant advances in the treatment of peptic ulcers have occurred during the last 25 years. Two important problem areas remain: resistant ulcers and ulcer relapse. Ulcers that remain unhealed after 8 weeks of treatment with full doses of active anti-ulcer drugs are considered resistant. Risk factors for the development of resistance are known, the most important being non-compliance with recognized effective therapy. A correlation exists between healing of duodenal ulcers and degree of gastric acid suppression. A duodenal ulcer that fails to heal with mild suppression of gastric acidity may, therefore, respond to more potent and longer acting drugs, such as famotidine or omeprazole. Prescribing drugs that may improve the mucosal defence may also be useful. For gastric ulcers, prolonging treatment may be effective. Currently available drugs provide some protection from ulcer relapse, but the risk of an ulcer recurring remains. Most recurrences are asymptomatic and ulcers are most likely to recur within a relatively short period of time. Success in the treatment of resistant ulcers and maintenance therapy to prevent relapse may require greater understanding of the pathology of ulcers and application of drug therapy that specifically corrects these abnormalities.