Long-term management of peptic ulcer disease

Maintenance therapy to reduce the risk of ulcer relapse and subsequent ulcer complications should be offered to patients who are likely to suffer a relapse by virtue of their past history or current risk factors. The most effective form of ulcer maintenance therapy appears to be continuous low-dose nocturnal therapy with H2-receptor antagonists. Patients who are observed expectantly and develop recurrent ulcer symptoms can be treated with full-strength therapy on an intermittent basis. Patients with a definite seasonal trend to their ulcer disease may benefit from a seasonal approach to therapy. Ulcer surgery is reserved for patients with ulcer complications or severe symptoms unresponsive to standard maintenance therapy. Just how long continuous low-dose maintenance therapy can or should be continued remains unclear. Whether ulcer disease is ever truly cured (never to recur again), as suggested by pre-endoscopic studies, is a matter of conjecture. Nevertheless, the use of maintenance-dose therapy appears to be safe over relatively long periods of time, and it appears that cumulative ulcer relapse rates decline with continued use of such therapy. The risk of recurrent symptoms, hemorrhage, and other complications is also reduced by maintenance therapy, and the economic aspects of ulcer disease are influenced in a positive fashion by these regimens. The role that C. pylori will ultimately play in the etiology and pathogenesis of peptic ulcers and their relapse is still not known with any certainty, although it appears to represent an important marker (if not an important pathogenetic cause) for ulcer disease. As such, it may be considered a risk factor to be eliminated.(ABSTRACT TRUNCATED AT 250 WORDS)