Low dose maintenance treatment with cimetidine in duodenal ulcer: intermediate-term results

Abstract

Summary:Ulcer relapse rates during up to 2 years of prophylactic low-dose maintenance therapy (LDMT) with cimetidine 400 mg at bedtime was examined in 261 patients. Endoscopy was repeated every 6 months if asymptomatic, or whenever symptoms recurred. Relapse was defined as the recurrence of an ulcer crater or erosions or both.In patients with non-refractory duodenal ulcer (those healed within 3 months) who comprise the majority, their likelihood of relapse at 6, 12,18 and 24 months was: symptomatic 8%, 13%, 18%, 20%; silent 14%, 28%, 38%, 43%, respectively. In contrast, in patients with refractory ulcer, their symptomatic relapse rates were 36%, 45%, 46%, 48%, and silent 28%, 38%, 46%, 48% respectively.The outcome of a second course of LDMT was similar to the first. Narrowing the definition of relapse to exclude recurrence of erosions alone but without an ulcer decreased asymptomatic relapse in nonrefractory ulcer patients by about half. No patient had any major side effects.Thus, LDMT is a safe and effective way ofkeeping most patients with duodenal ulcer symptom free over 2 years.

Maintenance Treatment with H₂Receptor Antagonists for Duodenal Ulcer Disease: Toward a Rational Use

“…It does, however, signifi cantly reduce both the incidence of symptom atic recurrences and the point prevalence of asymptomatic recurrences [6][7][8][9] (the fraction of asymptomatic patients who. at any given time, have an endoscopically visible ulcer).…”

“…receptor antagonists and placebo might therefore result more from differences in symptom relief and rehealing rates than from an actual difference in the number of recur rences, though this question is controversial [17], There is reason to think that the rela tively high proportion of asymptomatic recur rences may be a consequence of maintenance The probability of symptomatic ulcer relapse and the risk of asymptomatic reulceration are calculated using standard life table analysis. 1 From Bardhan et al [7], 2 From Walan et al [20], therapy, since the effect is dose related: higher maintenance doses yield a greater proportion of asymptomatic recurrences, without further decreasing the total recurrence rate [ 18].…”

Clinical Review of Histamine2 Receptor Antagonists

“…Using this approach, 60% less cimetidine was used over the course of 1 year.75 Factors shown to have adverse effects on the relapse rate are ulcers requiring longer than 3 months to heal, smoking, and gastric ulcers associated with low acid secretion. 74,76,77 Hypersecretory States Hypersecretory states such as gastrinoma are more resis¬ tant to treatment. Failure rates of25% to 50% are common.…”

Surgery for Peptic Ulcer Disease in the Era of H₂ Receptor Blockers

“…(2) In patients over 50 years of age with a peptic ulcer there is a substantial (25%) risk of major haemorrhage occurring from the ulcer, over a 10-year period [4]. (3) The pro portion of patients who develop ulcer relapse whilst on maintenance H2 receptor blocker therapy may be as high as 50% in 12 months [5], (4) Lifelong maintenance therapy with H2 receptor blockers is more costly than sur gery [6], even in a country such as the USA, where surgical costs are high. If surveillance endoscopy to detect relapses is added, then the cost of lifelong maintenance therapy be comes even higher.…”