Maintenance cimetidine instead of surgery for duodenal ulcer: the first decade

Fifty five patients with severe longstanding dyspepsia originally selected as candidates for elective duodenal ulcer surgery were instead entered into a maintenance cimetidine study. Forty six have been reviewed after 10 years. Twenty patients had required surgery, all in the first three years, but six of them had proven or suspected recurrent ulceration during follow up. Twenty six patients avoided surgery, either with continuous cimetidine 400 mg nocte or intermittent full dose cimetidine. Of the 17 on continuous maintenance cimetidine, six had proven or suspected recurrent ulceration responding to full dose cimetidine. All nine patients on intermittent cimetidine experienced symptomatic relapse within eight to 12 weeks of drug withdrawal. By using cimetidine, 64% of patients selected for surgery have avoided operation over this 10 year period, although none has had drug free remission.