Parietal cell vagotomy or cimetidine maintenance therapy for duodenal ulcer? A prospective controlled trial

In a prospective controlled trial 86 duodenal ulcer patients with symptoms severe enough to indicate surgery were randomized to a full-dose cimetidine course followed by maintenance therapy for 1 year or parietal cell vagotomy (PCV). The average follow-up period was 57 months. In the group assigned to medical therapy 62% of the patients were free of symptoms during maintenance therapy, and 12% remained well during the follow-up period. Operation was later performed in 35%, whereas 53% had symptomatic recurrence demanding medical treatment regularly. After PCV no patient died, and there were no serious sequelae. The overall recurrence rate was 17%; after treatment of failures 9% continued to have dyspepsia. Since nearly 3/4 of the patients were free of symptoms after PCV, operation seems to be the method of choice in patients with a severe history and fast recurrence after medical therapy. However, the aged and those at high risk of surgery may benefit from cimetidine maintenance therapy.