Peptic ulcer recurrence during maintenance therapy with H-2-receptor antagonist following first-line therapy with proton pump inhibitor

We investigated the peptic ulcer recurrence rates during maintenance therap y with H-2-receptor antagonists (H2RAs) following first-line therapy with a proton pump inhibitor (PPI). Patients with gastric ulcer (CU) or duodenal ulcer (DU) were enrolled in this study; 583 eligible patients (GU, 325; DU, 258) were administered lansoprazole (30 mg/day for 8 weeks for GU, and the same dosage for 6 weeks for DU) as first-line therapy, and a half dose of H(2)RA as maintenance therapy for 12 months. Endoscopic photographs were ta ken before administration and after 8 (GU) and 6 (DU) weeks of lansoprazole administration, Ulcer stage was evaluated using the classification of Saki ta and Miwa. Endoscopic examinations were performed 6 months or 12 months a fter the start of maintenance therapy or when a recurrence was suspected be cause of the appearance of subjective symptoms. The healing rates for GU an d DU patients after completion of lansoprazole therapy were 79% in both gro ups, while the S-2-stage healing rates were 18% and 31%, respectively, At 1 year after the start of maintenance therapy, the recurrence rates were 25% for GU and 39% for DU patients. In DU patients, the recurrence rates from S-1-stage and S-2-stage were 49% and 20%, respectively (P = 0.004), but no significant difference was found between those rates in GU patients. The re currence rates in ri, pylori-positive patients before lansoprazole administ ration were 27% for OU and 43% for DU patients, We concluded that the maint enance therapy with a half-dose of H(2)RA following PPI therapy was insuffi cient to prevent recurrences of GU and DU.