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Efficacy of continuous therapy for peptic ulcer in controlled clinical trials
Author(s) -
DAMMANN H. G.,
WALTER T. A.
Publication year - 1993
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.1993.tb00595.x
Subject(s) - medicine , cimetidine , ranitidine , asymptomatic , perforation , concomitant , gastroenterology , disease , maintenance therapy , clinical trial , complication , surgery , chemotherapy , materials science , punching , metallurgy
SUMMARY Long‐term studies have confirmed unequivocally the clinical efficacy of continuous therapy with H 2 ‐receptor antagonists in reducing the incidence of ulcer recurrence. However, studies have also reported varying relapse rates as a result of differences in study design, particularly the frequency of endoscopy and hence the detection of asymptomatic ulcer relapse. Risk factors for ulcer relapse include smoking, stress, previous history of frequent ulcer relapses, duration of disease for more than 10 years and concomitant administration of non‐steroidal anti‐inflammatory drugs. In the prevention of relapse with H 2 ‐receptor antagonists, choice of agents also may influence the rate of relapse. A meta‐analysis of data from direct comparative trials indicates that recurrence rates of duodenal ulcer are significantly lower after one year of treatment with ranitidine (1 50 mg nocte) than with cimetidine (400 mg nocte). It has been claimed that patients with peptic ulcer disease can be successfully managed by intermittent courses of treatment with H 2 ‐receptor antagonists which are taken in response to the development of symptoms. However, high relapse rates (64–100%) have been reported during the first year of follow‐up of patients who were receiving intermittent treatment with H 2 ‐receptor antagonists. High complication rates (haemorrhage 11.4%, perforation 1.2 %) have also been reported over a seven‐year follow‐up, while continuous treatment with H 2 ‐receptor antagonists significantly decreases the risk of haemorrhage in the event of ulcer recurrence.