Drugs for the prevention of peptic ulcer recurrence

The treatment of chronic peptic ulcer involves the treatment of acute exacerbations and the complications, and the prevention of ulcer recurrence. Several drugs accelerate the initial healing of ulcer and include the H2-receptor antagonists (cimetidine and ranitidine), colloidal bismuth, sucralfate, pirenzepine, carbenoxolone sodium, prostaglandins, high dose antacids and trimipramine. The long term management of ulcer involves the use of drugs and, in selected patients, surgery. Drugs used in this context include H2-receptor antagonists, pirenzepine, sucralfate and probably prostaglandins when further trial evidence is available. Regimens of long term drug treatment include intermittent treatment and maintenance treatment. The former consists of no active treatment after the ulcer is healed and the treatment of each acute exacerbation when it occurs, this treatment involving any one of the several drug routines mentioned above. If exacerbations are frequent (i.e. more than 2 to 3 years), maintenance therapy with H2-receptor antagonists, pirenzepine or sucralfate is advised. If the ulcer recurs despite long term treatment, it may be healed again using the healing dose of the above agents, and maintenance therapy recommenced if the remission induced by maintenance therapy was several years. If the remission was short, surgery should be advised.