Skip to main content
Log in

Long Term Treatment of Duodenal Ulcer

A Review of Management Options

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Duodenal ulcer is a chronic disease characterised by remission and relapses. The duration of this relapsing tendency is unpredictable for the individual patient, but in most cases it lasts for many years and perhaps the entire lifetime. Various therapeutic strategies have been suggested to maintain the disease in remission: continuous, intermittent and on-demand treatment with H2-antagonists, or surgery. Continuous maintenance treatment with the currently available H2-blockers has proved to be superior to all the other strategies in terms of efficacy, and should therefore be regarded as the long term treatment of choice for duodenal ulcer patients. The duration of maintenance treatment is still uncertain, but probably it should not be less than a few years. Intermittent treatment or surgery could be proposed to patients unsuitable for continuous maintenance, depending on whether they have mild or aggressive disease, respectively

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Baglioni A, Barbara L, Bianchi Porro G, Blasi G, Canelli A, et al. Famotidine versus placebo in the prevention of duodenal ulcer relapse: a multicenter trial in Germany, Austria and Italy. Zeitschrift für Gastroenterologie 23(12): 665–669, 1985

    PubMed  CAS  Google Scholar 

  • Bank S, Marks IN, Louw JH. The long-term effects of vagotomy and drainage, parietal cell vagotomy and H2-receptor antagonists on duodenal ulcers and gastric function and structure. South African Medical Journal 57: 622–627, 1980

    PubMed  CAS  Google Scholar 

  • Bardhan KD, Cole DS, Hawkins BW, Franks CR. Does treatment with cimetidine extended beyond initial healing of duodenal ulcer reduce the subsequent relapse rate? British Medical Journal 284: 621–624, 1982

    Article  PubMed  CAS  Google Scholar 

  • Bardhan KD, for the Anglo-Irish Cimetidine Long-Term Study Group. Alimentary Pharmacology and Therapeutics 2: 395–405, 1988b

    Article  PubMed  CAS  Google Scholar 

  • Bardhan KD, Hunter JO, Miller JP, Thomson ABR, Graham DY, et al. Antacid maintenance therapy in the prevention of duodenal ulcer relapse. Gut 29: 1748–1754, 1988a

    Article  PubMed  CAS  Google Scholar 

  • Bardhan KD. Intermittent treatment of duodenal ulcer for long-term medical management: a review. Postgraduate Medical Journal 64 (Suppl. 1): 40–46, 1988

    PubMed  Google Scholar 

  • Bardhan KD. Refractory duodenal ulcer. Gut 25: 711–717, 1984

    Article  PubMed  CAS  Google Scholar 

  • Battaglia G, Farini R, Di Mario F, Piccoli A, Plebani M, et al. Recurrences of duodenal ulcer under continuous antisecretory treatment: an approach to the detection of predictive markers. American Journal of Gastroenterology 79: 831–834, 1984

    PubMed  CAS  Google Scholar 

  • Bianchi Porro G, Lazzaroni M, Barbara L, Corinaldesi R, Blasi A, et al. Famotidina o ranitidina nella profilassi delie recidive dell’ulcera duodenale. Argomenti di Gastroenterologia Clinica 2: 105–114, 1989

    Google Scholar 

  • Bianchi Porro G, Lazzaroni M. Campylobacter pylori and ulcer recurrence. Lancet 1: 593, 1988

    Article  PubMed  CAS  Google Scholar 

  • Bianchi Porro G, Lazzaroni M, Pace F, Petrillo M. Long-term low-dose antacid versus cimetidine therapy in the treatment of duodenal ulcer recurrence. Scandinavian Journal of Gastroenterology 21: 1144–1146, 1986

    Article  PubMed  CAS  Google Scholar 

  • Bianchi Porro G, Lazzaroni M, Parente F, Petrillo M. Medical treatment of duodenal ulcer: present status. In Bianchi Porro & Bardhan (Eds) Topics in peptic ulcer disease, pp. 35–68, Cortina International, Verona, 1987

    Google Scholar 

  • Bianchi Porro G, Petrillo M, Lazzaroni M, Sangaletti O. The longer-term treatment of duodenal ulceration with cimetidine. In Bianchi Porro & Bardhan (Eds) Peptic ulcer disease: advances in pathogenesis and treatment, pp. 107–113, Cortina International, Verona, 1982

    Google Scholar 

  • Bianchi Porro G, Petrillo M. The natural history of peptic ulcer disease: the influence of H2-antagonist treatment. Scandinavian Journal of Gastroenterology 21 (Suppl. 121): 46–52, 1986

    Article  Google Scholar 

  • Bianchi Porro G. Symposium proceedings. XII International Congress of Gastroenterology, Lisbon, pp. 33–38, Universitets for laget, Oslo, 1985

  • Blasi A, Mangiameli A, Castelli G, Girelli M, Familiari L, et al. Long-term (24 month) ranitidine in prevention of duodenal ulcer relapses: comparison of continuous and seasonal treatment. Italian Journal of Gastroenterology 19: 141–144, 1987

    Google Scholar 

  • Bodemar G, Gotthard R, Strom M, Walan A. Maintenance treatment, part 1: length of therapy and indictions. In Baron JH (Ed.) Cimetidine in the 80s, pp. 75–84, Churchill Livingstone, Edinburgh, 1981

    Google Scholar 

  • Borody T, Cole P, Noonan S, Morgan A, Ossip G, et al. Long-term Campylobacter pylori recurrence post-eradication. Gastroenterology 94: A43, 1988

    Google Scholar 

  • Borody T, Noonan S, Cole P, Hyland L, Morgan A, et al. Duodenal ulcer recurrence in patients remaining C. pylori (CP)-negative long term post-eradication. Gastroenterology 96: A52, 1989

    Google Scholar 

  • Boyd EJS, Wilson JA, Wormsley KG. Recurrent ulcer disease. In Misiewicz JJ & Wood JR (Eds) Ranitidine: therapeutic advances, pp. 14–42, Excerpta Medica, Amsterdam, 1984a

    Google Scholar 

  • Boyd EJS, Wilson JA, Wormsley KG. Safety of ranitidine maintenance treatment of duodenal ulcer. Scandinavian Journal of Gastroenterology 19: 394–400, 1984b

    PubMed  CAS  Google Scholar 

  • Boyd EJS, Wilson JA, Wormsley KG. The natural history of asymptomatic duodenal ulcer recurrences. Scandinavian Journal of Gastroenterology 19: 808–812, 1984c

    PubMed  CAS  Google Scholar 

  • Brown P, Salmon PR, Neumann CS, Whittington JR, Read AG. Comparison of carbenoxolone sodium (Duogastrone) and cimetidine (Tagamet) in duodenal ulceration. Gut 20: A904, 1979

    Google Scholar 

  • Cerulli MA, Cloud ML, Offen WW, Chernish SM, Matsumoto C. Nizatidine as maintenance therapy of duodenal ulcer disease in remission. Scandinavian Journal of Gastroenterology 22 (Suppl. 136): 79–83, 1987

    Article  Google Scholar 

  • Classen M, Bethge H, Brunner G, Dirr B, Frutz H, et al. Effect of sucralfate on peptic ulcer recurrence: a controlled double-blind multicenter study. Scandinavian Journal of Gastroenterology 18 (Suppl. 83): 61–68, 1983

    Google Scholar 

  • Coghlan JG, Gilligan D, Humphries H, McKenna DM, Dooley G, et al. Campylobacter pylori and recurrence of duodenal ulcers: a 12 month follow-up study. Lancet 2: 1109–1111, 1987

    Article  PubMed  CAS  Google Scholar 

  • Colin-Jones DG, Langman MJS, Lawson DH, Veskey MP. Review: post-marketing surveillance of the safety of cimetidine. The problems of data interpretation. Alimentary Pharmacology and Therapeutics 1: 167–177, 1987

    Article  Google Scholar 

  • Cook PJ, Vincent-Brown A, Lewis SI, Perks S, Jewell DP, et al. Carbenoxolone (Duogastrone) and cimetidine in the treatment of duodenal ulcer: a therapeutic trial. Scandinavian Journal of Gastroenterology 15 (Suppl. 65): 93–101, 1980

    Google Scholar 

  • Dobrilla G, Chilovi F. Long-term prophylaxis of peptic ulcer with non-H2-antagonist drugs. Current Therapeutic Research 40: 1147–1157, 1986

    Google Scholar 

  • Dobrilla G, Vallaperta P, Amplatz S. Influence of ulcer healing agents on ulcer relapse after discontinuation of acute treatment: a pooled estimate of controlled clinical trials. Gut 29: 181–187, 1988

    Article  PubMed  CAS  Google Scholar 

  • Dotevall G. Psychological approach to peptic ulcer disease. In Di Mario et al. (Eds) New trends in ulcer disease: heterogeneity, subclinical markers, treatment, pp. 195–208, Piccin, Padua, 1988

    Google Scholar 

  • Dronfield MW, Batchelor AJ, Larkworthy W, Langman MJS. Controlled trial of maintenance cimetidine treatment in healed duodenal ulcers: short and long-term effects. Gut 20: 526–530, 1979

    Article  PubMed  CAS  Google Scholar 

  • de Gara CJ, Burget DW, Silletti C, Hunt RH. A double-blind randomized study comparing different dose regimens of H2-receptor antagonists on 24-hour gastric secretion in normal subjects and duodenal ulcer patients. American Journal of Gastroenterology 82: 36–41, 1987

    PubMed  Google Scholar 

  • Friedman GD, Siegelaub AB, Seltzer CC. Cigarettes, alcohol, coffee and peptic ulcer. New England Journal of Medicine 290: 469–473, 1974

    Article  PubMed  CAS  Google Scholar 

  • Fry J. Peptic ulcer: a profile. British Medical Journal 2: 809–812, 1964

    Article  PubMed  CAS  Google Scholar 

  • Gear MW. Proximal gastric vagotomy versus long-term maintenance treatment with cimetidine for chronic duodenal ulcer: a prospective randomized trial. British Journal of Medicine 286: 98–99, 1983

    Article  CAS  Google Scholar 

  • Gledhill T, Johnston D, Rogers M, Holmfield J, Primrose JN. The role of surgery in the long term management of duodenal ulcer. Research and Clinical Forums 10: 95–102, 1988

    Google Scholar 

  • Goodwin CS, Armstrong JA, Chilvers T. Transfer of Campylobacter pylori and Campylobacter mustelae to Helicobacter gen nov as Helicobacter pylori comb nov and Helicobacter mustelae comb nov, respectively. International Journal of Systematic Bacteriology 39: 397–405, 1989

    Article  Google Scholar 

  • Gough KR, Korman MG, Bardhan KD, Lee Fl, Crowe JP, et al. Ranitidine and cimetidine in the prevention of duodenal ulcer relapse: a double-blind, randomised, multicentre, comparative trial. Lancet 2: 659–663, 1984

    Article  PubMed  CAS  Google Scholar 

  • Greibe J, Bugge P, Gjorup T, Gjørup T, Lauritzen T, et al. Long-term prognosis of duodenal ulcer: follow-up study and survey of doctors’ estimates. British Medical Journal 2: 1572–1574, 1977

    Article  PubMed  CAS  Google Scholar 

  • Gustavsson S, Holmberg L, Nyren O, Ohrvall U, Wells L. Risk of serious complications in patients with duodenal or prepyloric ulcers. Gastroenterology 98: 54A, 1990

    Google Scholar 

  • Hamilton I, O’Connor HJ, Wood NC, Bradbury I, Axon ATR. Healing and recurrence of duodenal ulcer after treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine. Gut 27: 106–110, 1986

    Article  PubMed  CAS  Google Scholar 

  • Hansen JH, Nigge U. Failure of proximal gastric vagotomy for duodenal ulcer resistant to cimetidine. Lancet 2: 84–86, 1984

    Article  PubMed  CAS  Google Scholar 

  • Harling H, Balslev I, Bentzen E. Parietal cell vagotomy or cimetidine maintenance therapy for duodenal ulcer? A prospective controlled trial. Scandinavian Journal of Gastroenterology 20: 747–750, 1985

    Article  PubMed  CAS  Google Scholar 

  • Hentschel E, Schutze K, Reichel W, Kerstan E, Kratochvil P, et al. Nizatidine versus ranitidine in the prevention of duodenal ulcer relapse: six-month interim results of a European multi-centre study. Scandinavian Journal of Gastroenterology 22 (Suppl. 136): 84–88, 1987

    Article  Google Scholar 

  • Ho J, Hui W-M, Ng I, Lam SK. Natural history of Campylobacter pylori in duodenal ulceration treated with an H2-antagonist. Alimentary Pharmacology and Therapeutics 3: 315–320, 1989

    Article  PubMed  CAS  Google Scholar 

  • Hunt RH, Howden CW, Jones DB, Burget DW, Kerr GD. The correlation between acid suppression and peptic ulcer healing. Scandinavian Journal of Gastroenterology 21 (Suppl. 125): 22–29, 1986

    Article  Google Scholar 

  • Kerr GD. H2-receptor antagonists and duodenal ulcer healing: the international experience. In Cohen S (Ed.) Update: H2 receptor antagonists, pp. 69–74, Biomedical Information Corporation, New York, 1984

    Google Scholar 

  • Kikendall JW, Evaul J, Johnson LF. Effect of cigarette smoking on gastrointestinal physiology and non-neoplastic digestive disease. Journal of Clinical Gastroenterology 6: 65–79, 1984

    PubMed  CAS  Google Scholar 

  • Korman MG, Hansky J, Eaves ER, Schmidt GT. Influence of cigarette smoking on healing and relapse in duodenal ulcer disease. Gastroenterology 85: 871–874, 1983

    PubMed  CAS  Google Scholar 

  • Kurata JH, Haile BM, Elashoff JD. Sex differences in peptic ulcer disease. Gastroenterology 88: 96–102, 1985

    PubMed  CAS  Google Scholar 

  • Lam SK, Hui WM, Lau WY, Bronicki FJ, Lai CL, et al. Sucralfate overcomes adverse effect of cigarette smoking on duodenal ulcer healing and prolongs subsequent remission. Gastroenterology 92: 1193–1201, 1987

    PubMed  CAS  Google Scholar 

  • Lambert JR, Borromeo M, Korman MG, Hansky J, Eaves ER. Effect of colloidal bismuth (De-Nol) on healing and relapse of duodenal ulcers: role of Campylobacter pyloridis. Gastroenterology 92: 1489, 1987

    Google Scholar 

  • Lane MR, Lee SP. Recurrence of duodenal ulcer after medical treatment. Lancet 1: 1147–1149, 1988

    Article  PubMed  CAS  Google Scholar 

  • Lee FI, Samloff IM, Hardman M. Comparison of tripotassium dicitrato bismuthate tablets with ranitidine in healing and relapse of duodenal ulcers. Lancet 1: 1299–1301, 1985

    Article  PubMed  CAS  Google Scholar 

  • Malmros H, Hiertonn T. A post-investigation of 687 medically treated cases of peptic ulcer. Acta Medica Scandinavica 133: 229–235, 1949

    Article  PubMed  CAS  Google Scholar 

  • Marks IN, Girwood AH. Maintenance sucralfate and duodenal ulcer relapse: an interim report. Scandinavian Journal of Gastroenterology 18 (Suppl. 83): 71–73, 1983

    Google Scholar 

  • Marks IN, Wright JP, Lucke W, Girdwood AH. Relapse rates after initial ulcer healing with sucralfate and cimetidine. Scandinavian Journal of Gastroenterology 17: 429–432, 1982

    Article  PubMed  CAS  Google Scholar 

  • Marshall BJ, Goodwin CS, Warren JR, Murray R, Blincow ED, et al. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet 2: 1437–1441, 1988

    Article  PubMed  CAS  Google Scholar 

  • Martin DF, Hollanders D, May SJ, Ravenscroft MM, Tweedle DEF, et al. Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate. Lancet 1: 7–10, 1981

    Article  PubMed  CAS  Google Scholar 

  • Masoero G, Rocchia F, Rossanino A, Marchetto M, Benitti V, et al. Comparison of ranitidine and sucralfate in the long-term treatment of duodenal ulcer. Journal of Clinical Gastroenterology 8(6): 624–627, 1986

    Article  PubMed  CAS  Google Scholar 

  • McKay AJ, McArdle CS. Cimetidine and perforated peptic ulcer. British Journal of Surgery 69: 319–322, 1982

    Article  PubMed  CAS  Google Scholar 

  • McLean AJ, Harcourt DM, McCarthy PG, Dudley FJ, McNeil JJ. Relative effectiveness and costs of antiulcer medications as a basis for rational prescribing. Medical Journal of Australia 146: 431–439, 1987

    PubMed  CAS  Google Scholar 

  • Meyer JH. Chronic morbidity after ulcer surgery. In Sleisenger & Fordtran (Eds) Gastrointestinal disease: pathophysiology, diagnosis, management, pp. 962–987, Saunders, Philadelphia, 1989

    Google Scholar 

  • Offerhaus GJA, Huibregtse K, DeBoer J, Verhoeven T, Van Olffen GH, et al. The operated stomach: premalignant condition. Scandinavian Journal of Gastroenterology 19: 521–525, 1984

    PubMed  CAS  Google Scholar 

  • Paoluzi P, Ricotta G, Ripoli F, et al. Incompletely and completely healed duoendal ulcers’ outcome in maintenance treatment: a double blind controlled study. Gut 26: 1080–1085, 1985

    Article  PubMed  CAS  Google Scholar 

  • Penston J, Wormsley KG. Efficacy and safety of long-term maintenance therapy of duodenal ulcers. Scandinavian Journal of Gastroenterology 24: 1145–1152, 1989

    Article  PubMed  CAS  Google Scholar 

  • Primrose JN, Axon ATR, Johnston D. Highly selective vagotomy and duodenal ulcers that fail to repond to H2receptor antagonists. British Journal of Medicine 296: 1031–1035, 1988

    Article  CAS  Google Scholar 

  • Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet 335: 1233–1235, 1990

    Article  PubMed  CAS  Google Scholar 

  • Rotter JI. Peptic ulcer. In Emery AEH & Rimoin DL (Eds) The principles and practice of medical genetics, pp. 863–878, Churchill Livingstone, New York, 1983

    Google Scholar 

  • Rydning A, Berstad A, Aadland E, Odegaard B. Prophylactic effect of dietary fibre in duodenal ulcer disease. Lancet 2: 736–739, 1982

    Article  PubMed  CAS  Google Scholar 

  • Salena BJ, Hunt RH. Relapse of duodenal ulcer. British Medical Journal 293: 1570 1986

    Article  Google Scholar 

  • Schiller LR, Fordtran JS. Ulcer complications during short-term therapy of duodenal ulcer with active agents and placebo. Gastroenterology 90: 478–481, 1986

    PubMed  CAS  Google Scholar 

  • Shreeve DR, Klass HJ, Jones PE. Comparison of cimetidine and tripotassium dicitrato bismuthate in healing and relapse of duodenal ulcer. Digestion 28: 96–101, 1983

    Article  PubMed  CAS  Google Scholar 

  • Silvis SE. Final report on the United States multicenter trial comparing ranitidine to cimetidine as maintenance therapy following healing of duodenal ulcer. Journal of Clinical Gastroenterology 7(6): 482–487, 1985

    Article  PubMed  CAS  Google Scholar 

  • Smith AC, Price AB, Borriello P, Levi AJ. A comparison of ranitidine and tripotassium dicitrato bismuthate (TDB) in relapse rates of duodenal ulcer: the role of Campylobacter pylori (CP). Gut 29(A): 711, 1988

    Google Scholar 

  • Sonnenberg A, Muller-Lissner SA, Vogel E, Schmid P, Gonvers JJ, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology 81: 1061–1067, 1981

    PubMed  CAS  Google Scholar 

  • Sonnenberg A: Occurrence of a cohort phenomenon in peptic ulcer mortality from Switzerland. Gastroenterology 86: 398–401, 1984

    PubMed  CAS  Google Scholar 

  • Sontag S, Graham DY, Belsito A, Weiss J, et al. Cimetidine, cigarette smoking and recurrence of duodenal ulcer. New England Journal of Medicine 311: 689–693, 1984

    Article  PubMed  CAS  Google Scholar 

  • Strom M, Bodemar G, Lindhagen J, Sjödahl R, Walan A. Cimetidine or parietal cell vagotomy in patients with juxtapyloric ulcers. Lancet 2: 894–897, 1984

    Article  PubMed  CAS  Google Scholar 

  • Takemoto T, Kimura K, Okita K, Tsuneoka K, Ohshiba S, et al. Efficacy of sucralfate in the prevention of recurrence of peptic ulcer: double blind multicenter study with cimetidine. Scandinavian Journal of Gastroenterology 22 (Suppl. 140): 49–60, 1987

    Google Scholar 

  • Texter EC, Navab JF, Mantell G, Berman R. Maintenance therapy of duodenal ulcer with famotidine: a multicenter United States study. American Journal of Medicine 81 (Suppl. 4B): 25–32, 1986

    Article  PubMed  Google Scholar 

  • Thomson WO, Joffe SN, Robertson AC, Lee FD, Imrie CW, et al. Is duodenitis a dyspeptic myth? Lancet 1: 1197–1198, 1977

    Article  PubMed  CAS  Google Scholar 

  • Thorat VK, Misra SP, Anand BS. Conventional versus on-demand therapy for duodenal ulcer: results of a controlled therapeutic trial. American Journal of Gastroenterology 85: 243–248, 1990

    PubMed  CAS  Google Scholar 

  • Venables CW. The value of long-term maintenance treatment in peptic ulcer. In Bianchi Porro & Bardhan (Eds) Topics in peptic ulcer disease, pp. 115–122, Cortina International, Verona, 1987

    Google Scholar 

  • Vezzadini P, Sternini C, Bonora G, Botti PL, Lugli C, et al. Relapse rates of duodenal ulcer after healing with pirenzepine or cimetidine: a double-blind study. Abstract. Scandinavian Journal of Gastroenterology 17 (Suppl. 78): 100, 1982

    Google Scholar 

  • Viskum A. A comparison of the course of the disease among patients with gastric ulcer, duodenal ulcer, and ulcer dyspepsia without ulcer demonstrable by X-ray. Danish Medical Bulletin 23: 129–135, 1976

    PubMed  CAS  Google Scholar 

  • Wade AG, Rowley-Jones D. Long-term management of duodenal ulcer in general practice: how best to use cimetidine? British Medical Journal 296: 971–974, 1988

    Article  PubMed  CAS  Google Scholar 

  • Walan A, Bianchi Porro G, Hentschel E, Bardhan KD, Delattre M. Maintenance treatment with cimetidine in peptic ulcer disease for up to four years. Scandinavian Journal of Gastroenterology 22: 397–405, 1987

    Article  PubMed  CAS  Google Scholar 

  • Wallace WA, Orr CME, Beam AR. Perforation of chronic peptic ulcers after cimetidine. British Medical Journal 2: 865–866, 1977

    Article  PubMed  CAS  Google Scholar 

  • Wormsley KG. Is chronic long-term inhibition of gastric secretion really dangerous? Scandinavian Journal of Gastroenterology 23 (Suppl. 146): 166–174, 1988

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bianchi Porro, G., Parente, F. Long Term Treatment of Duodenal Ulcer. Drugs 41, 38–51 (1991). https://doi.org/10.2165/00003495-199141010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199141010-00004

Keywords

Navigation