An aggressive approach to the medical management of peptic ulcer disease

Studies indicate that endoscopy provides the best index for accurate diagnosis of peptic ulcer and for evaluating results of therapy. The use of cimetidine or frequent administration of a potent liquid antacid ensures initial healing of duodenal ulcers in 75% to 90% of patients. A similar, but not so clearly statistically significant, trend toward healing exists when cimetidine is used in gastric ulcers. Cimetidine also is useful in postsurgical ulcers, in the Zollinger-Ellison syndrome, and as prophylaxis (up to one year) in patients with healed duodenal ulcers. Although the long-term effects of healing ulcers and preventing relapses remain to be defined, an aggressive approach toward healing and the management of the healed state seems advisable. The frequent use of endoscopy as a diagnostic tool plus vigorous application of proved medical therapy is advocated.