A decade of experience with long-term continuous treatment of peptic ulcers with H2-receptor antagonists

Patients with peptic ulcer disease are troubled by recurrent episodes of ulcer pain, and remain at risk of developing the serious and occasionally lethal complications of haemorrhage and perforation. As the disease is chronic and persists over many years, a long-term strategy for the management of patients with peptic ulcer is required. Continuous, long-term treatment with H2-receptor antagonists successfully achieves the dual objectives of preventing painful ulcer recurrence and reducing the risk of complications. During nine years of continuous therapy with ranitidine, more than 80% of patients with duodenal ulcers remain free from symptomatic ulcer recurrence, less than 2% suffer from ulcer haemorrhage, and the risk of perforation is 0%. Similar beneficial effects of long-term treatment have been observed in patients with gastric ulcer. Long-term continuous treatment with H2-receptor antagonists may not alter the natural history of ulcer disease. Even after seven years of continuous therapy with ranitidine, ulcers recur in 50% of patients within six months of stopping treatment. Hence, long-term therapy with H2-receptor antagonists may need to be continued beyond 10 years. Patients with peptic ulcer who are elderly, those taking NSAIDs, aspirin or anti-coagulants, those with a previous history of an ulcer complication and those with serious co-existent disease are at increased risk from haemorrhage and perforation. These patients should receive long-term prophylactic therapy with an H2-receptor antagonist.