Rational approach to long-term use of H2-antagonists.

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Histamine (H2) receptor-antagonists are frequently prescribed for conditions beyond their approved indications.
• Lack of definitive guidelines for long-term H2 receptor-antagonist use contributes to indiscriminate prescribing.

Purpose of the Study:

• To review the appropriate patient selection for long-term histamine (H2) receptor-antagonist therapy.
• To discuss the efficacy and duration of therapy for various gastrointestinal conditions.

Main Methods:

• Literature review of clinical trials and established guidelines.
• Analysis of patient populations who may benefit from maintenance H2 receptor-antagonist therapy.

Main Results:

• Long-term H2 receptor-antagonist therapy is beneficial for duodenal ulcer recurrence in smokers and those with prior complications.
• Consideration for gastric ulcer prophylaxis in elderly NSAID users and patients with poor surgical candidates.
• Potential role in reflux esophagitis, scleroderma, Barrett's esophagus, and miscellaneous conditions like cystic fibrosis.

Conclusions:

• Patient selection for long-term H2 receptor-antagonist therapy requires individualized assessment.
• Efficacy is documented for duodenal ulcers up to three years; duration and benefit are less established for gastric ulcers and reflux esophagitis.
• Indefinite therapy may be necessary for certain miscellaneous gastrointestinal conditions.