Problems in the treatment of peptic ulcer

Although apparently very successful, the treatment of peptic ulcers remains unsatisfactory because therapy is still symptomatic. Consequently, debate continues about the proper objectives of therapy. Some clinicians consider it best to treat the patients' subjective symptoms, while others focus on the "objective" sign of mucosal ulceration. The latter seems more appropriate, since mucosal ulceration may result in lethal complications. It is therefore necessary not only to heal ulcers, but to keep them healed. The choice of optimal treatment of present ulcer relapse is determined not only by therapeutic success, but also by the frequency and severity of the iatrogenic diseases produced by the treatment. At the present time, maintenance treatment of proven efficacy is provided only by H2 receptor antagonists and is superior to operative therapy because it is accompanied by a lesser incidence of death and adverse reactions.