Initial therapy and relapse of duodenal ulcer: possible acid secretory mechanisms

Review of the four studies investigating the effect of initial therapy on ulcer relapse indicates that there is an increased rate of relapse after treatment with H2-receptor antagonists compared with placebo or other classes of drugs when combined. When individual drugs are considered, this appears to hold true for colloidal bismuth alone. There are several possible reasons for these differences. The most likely candidate mechanism to account for these differences is an alteration in gastric secretion, which might arise from alterations in gastrin, altered receptor regulation, parietal cell sensitivity, or peptic activity. However, the evidence for such an alteration in secretion is far from conclusive. Other factors that may be important include mucosal defense factors, smoking, Campylobacter pylori, and the statistical methodology.