THE NEED FOR LONG-TERM TREATMENT OF PEPTIC-ULCER

Some 10% of the population in Western countries will suffer a duodenal ulcer or gastric ulcer at some time in their lives. Although there ha s been an improvement in the survival rate of patients with peptic ulc er haemorrhage, the mortality is still approximately 10%. There is evi dence to suggest that peptic ulcer disease is a life-long condition an d that ulcers remain active with an unchanged potential for complicati ons such as haemorrhage and perforation. Over the past 15 years anti-u lcer drugs with different mechanisms of action have been developed, an d their use results in complete healing of an ulcer in four to eight w eeks. However, most patients experience recurrence of their peptic ulc er after discontinuation of the healing therapy. Studies of continuous H-2-receptor antagonist therapy have shown that recurrence occurs les s frequently than in untreated patients, is largely asymptomatic, and is rarely characterized by haemorrhagic complications. Limited data on therapy for the eradication of Helicobacter pylori suggest that this may be an alternative approach for selected patients. As protection af forded by H-2-receptor antagonists remains undiminished over the cours e of several years and is also observed in ulcers which have bled in t he past, the implementation of long-term management with these agents constitutes a rational policy.