Drugs

, Volume 41, Issue 1, pp 38–51 | Cite as

Long Term Treatment of Duodenal Ulcer

A Review of Management Options
  • G. Bianchi Porro
  • F. Parente
Review Article

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

Keywords

Cimetidine Duodenal Ulcer Ranitidine Sucralfate Pirenzepine 

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References

  1. 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, 1985PubMedGoogle Scholar
  2. 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, 1980PubMedGoogle Scholar
  3. 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, 1982PubMedCrossRefGoogle Scholar
  4. Bardhan KD, for the Anglo-Irish Cimetidine Long-Term Study Group. Alimentary Pharmacology and Therapeutics 2: 395–405, 1988bPubMedCrossRefGoogle Scholar
  5. 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, 1988aPubMedCrossRefGoogle Scholar
  6. Bardhan KD. Intermittent treatment of duodenal ulcer for long-term medical management: a review. Postgraduate Medical Journal 64 (Suppl. 1): 40–46, 1988PubMedGoogle Scholar
  7. Bardhan KD. Refractory duodenal ulcer. Gut 25: 711–717, 1984PubMedCrossRefGoogle Scholar
  8. 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, 1984PubMedGoogle Scholar
  9. 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, 1989Google Scholar
  10. Bianchi Porro G, Lazzaroni M. Campylobacter pylori and ulcer recurrence. Lancet 1: 593, 1988PubMedCrossRefGoogle Scholar
  11. 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, 1986PubMedCrossRefGoogle Scholar
  12. 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, 1987Google Scholar
  13. 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, 1982Google Scholar
  14. 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, 1986CrossRefGoogle Scholar
  15. Bianchi Porro G. Symposium proceedings. XII International Congress of Gastroenterology, Lisbon, pp. 33–38, Universitets for laget, Oslo, 1985Google Scholar
  16. 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, 1987Google Scholar
  17. 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, 1981Google Scholar
  18. Borody T, Cole P, Noonan S, Morgan A, Ossip G, et al. Long-term Campylobacter pylori recurrence post-eradication. Gastroenterology 94: A43, 1988Google Scholar
  19. 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, 1989Google Scholar
  20. Boyd EJS, Wilson JA, Wormsley KG. Recurrent ulcer disease. In Misiewicz JJ & Wood JR (Eds) Ranitidine: therapeutic advances, pp. 14–42, Excerpta Medica, Amsterdam, 1984aGoogle Scholar
  21. Boyd EJS, Wilson JA, Wormsley KG. Safety of ranitidine maintenance treatment of duodenal ulcer. Scandinavian Journal of Gastroenterology 19: 394–400, 1984bPubMedGoogle Scholar
  22. Boyd EJS, Wilson JA, Wormsley KG. The natural history of asymptomatic duodenal ulcer recurrences. Scandinavian Journal of Gastroenterology 19: 808–812, 1984cPubMedGoogle Scholar
  23. Brown P, Salmon PR, Neumann CS, Whittington JR, Read AG. Comparison of carbenoxolone sodium (Duogastrone) and cimetidine (Tagamet) in duodenal ulceration. Gut 20: A904, 1979Google Scholar
  24. 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, 1987CrossRefGoogle Scholar
  25. 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, 1983Google Scholar
  26. 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, 1987PubMedCrossRefGoogle Scholar
  27. 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, 1987CrossRefGoogle Scholar
  28. 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, 1980Google Scholar
  29. Dobrilla G, Chilovi F. Long-term prophylaxis of peptic ulcer with non-H2-antagonist drugs. Current Therapeutic Research 40: 1147–1157, 1986Google Scholar
  30. 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, 1988PubMedCrossRefGoogle Scholar
  31. 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, 1988Google Scholar
  32. 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, 1979PubMedCrossRefGoogle Scholar
  33. 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, 1987PubMedGoogle Scholar
  34. Friedman GD, Siegelaub AB, Seltzer CC. Cigarettes, alcohol, coffee and peptic ulcer. New England Journal of Medicine 290: 469–473, 1974PubMedCrossRefGoogle Scholar
  35. Fry J. Peptic ulcer: a profile. British Medical Journal 2: 809–812, 1964PubMedCrossRefGoogle Scholar
  36. 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, 1983CrossRefGoogle Scholar
  37. 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, 1988Google Scholar
  38. 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, 1989CrossRefGoogle Scholar
  39. 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, 1984PubMedCrossRefGoogle Scholar
  40. 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, 1977PubMedCrossRefGoogle Scholar
  41. Gustavsson S, Holmberg L, Nyren O, Ohrvall U, Wells L. Risk of serious complications in patients with duodenal or prepyloric ulcers. Gastroenterology 98: 54A, 1990Google Scholar
  42. 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, 1986PubMedCrossRefGoogle Scholar
  43. Hansen JH, Nigge U. Failure of proximal gastric vagotomy for duodenal ulcer resistant to cimetidine. Lancet 2: 84–86, 1984PubMedCrossRefGoogle Scholar
  44. 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, 1985PubMedCrossRefGoogle Scholar
  45. 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, 1987CrossRefGoogle Scholar
  46. 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, 1989PubMedCrossRefGoogle Scholar
  47. 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, 1986CrossRefGoogle Scholar
  48. 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, 1984Google Scholar
  49. 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, 1984PubMedGoogle Scholar
  50. Korman MG, Hansky J, Eaves ER, Schmidt GT. Influence of cigarette smoking on healing and relapse in duodenal ulcer disease. Gastroenterology 85: 871–874, 1983PubMedGoogle Scholar
  51. Kurata JH, Haile BM, Elashoff JD. Sex differences in peptic ulcer disease. Gastroenterology 88: 96–102, 1985PubMedGoogle Scholar
  52. 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, 1987PubMedGoogle Scholar
  53. 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, 1987Google Scholar
  54. Lane MR, Lee SP. Recurrence of duodenal ulcer after medical treatment. Lancet 1: 1147–1149, 1988PubMedCrossRefGoogle Scholar
  55. 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, 1985PubMedCrossRefGoogle Scholar
  56. Malmros H, Hiertonn T. A post-investigation of 687 medically treated cases of peptic ulcer. Acta Medica Scandinavica 133: 229–235, 1949PubMedCrossRefGoogle Scholar
  57. Marks IN, Girwood AH. Maintenance sucralfate and duodenal ulcer relapse: an interim report. Scandinavian Journal of Gastroenterology 18 (Suppl. 83): 71–73, 1983Google Scholar
  58. 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, 1982PubMedCrossRefGoogle Scholar
  59. 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, 1988PubMedCrossRefGoogle Scholar
  60. 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, 1981PubMedCrossRefGoogle Scholar
  61. 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, 1986PubMedCrossRefGoogle Scholar
  62. McKay AJ, McArdle CS. Cimetidine and perforated peptic ulcer. British Journal of Surgery 69: 319–322, 1982PubMedCrossRefGoogle Scholar
  63. 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, 1987PubMedGoogle Scholar
  64. Meyer JH. Chronic morbidity after ulcer surgery. In Sleisenger & Fordtran (Eds) Gastrointestinal disease: pathophysiology, diagnosis, management, pp. 962–987, Saunders, Philadelphia, 1989Google Scholar
  65. 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, 1984PubMedGoogle Scholar
  66. 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, 1985PubMedCrossRefGoogle Scholar
  67. Penston J, Wormsley KG. Efficacy and safety of long-term maintenance therapy of duodenal ulcers. Scandinavian Journal of Gastroenterology 24: 1145–1152, 1989PubMedCrossRefGoogle Scholar
  68. 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, 1988CrossRefGoogle Scholar
  69. Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet 335: 1233–1235, 1990PubMedCrossRefGoogle Scholar
  70. Rotter JI. Peptic ulcer. In Emery AEH & Rimoin DL (Eds) The principles and practice of medical genetics, pp. 863–878, Churchill Livingstone, New York, 1983Google Scholar
  71. Rydning A, Berstad A, Aadland E, Odegaard B. Prophylactic effect of dietary fibre in duodenal ulcer disease. Lancet 2: 736–739, 1982PubMedCrossRefGoogle Scholar
  72. Salena BJ, Hunt RH. Relapse of duodenal ulcer. British Medical Journal 293: 1570 1986CrossRefGoogle Scholar
  73. Schiller LR, Fordtran JS. Ulcer complications during short-term therapy of duodenal ulcer with active agents and placebo. Gastroenterology 90: 478–481, 1986PubMedGoogle Scholar
  74. Shreeve DR, Klass HJ, Jones PE. Comparison of cimetidine and tripotassium dicitrato bismuthate in healing and relapse of duodenal ulcer. Digestion 28: 96–101, 1983PubMedCrossRefGoogle Scholar
  75. 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, 1985PubMedCrossRefGoogle Scholar
  76. 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, 1988Google Scholar
  77. Sonnenberg A, Muller-Lissner SA, Vogel E, Schmid P, Gonvers JJ, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology 81: 1061–1067, 1981PubMedGoogle Scholar
  78. Sonnenberg A: Occurrence of a cohort phenomenon in peptic ulcer mortality from Switzerland. Gastroenterology 86: 398–401, 1984PubMedGoogle Scholar
  79. 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, 1984PubMedCrossRefGoogle Scholar
  80. Strom M, Bodemar G, Lindhagen J, Sjödahl R, Walan A. Cimetidine or parietal cell vagotomy in patients with juxtapyloric ulcers. Lancet 2: 894–897, 1984PubMedCrossRefGoogle Scholar
  81. 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, 1987Google Scholar
  82. 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, 1986PubMedCrossRefGoogle Scholar
  83. Thomson WO, Joffe SN, Robertson AC, Lee FD, Imrie CW, et al. Is duodenitis a dyspeptic myth? Lancet 1: 1197–1198, 1977PubMedCrossRefGoogle Scholar
  84. 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, 1990PubMedGoogle Scholar
  85. 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, 1987Google Scholar
  86. 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, 1982Google Scholar
  87. 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, 1976PubMedGoogle Scholar
  88. 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, 1988PubMedCrossRefGoogle Scholar
  89. 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, 1987PubMedCrossRefGoogle Scholar
  90. Wallace WA, Orr CME, Beam AR. Perforation of chronic peptic ulcers after cimetidine. British Medical Journal 2: 865–866, 1977PubMedCrossRefGoogle Scholar
  91. Wormsley KG. Is chronic long-term inhibition of gastric secretion really dangerous? Scandinavian Journal of Gastroenterology 23 (Suppl. 146): 166–174, 1988CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1991

Authors and Affiliations

  • G. Bianchi Porro
    • 1
  • F. Parente
    • 1
  1. 1.Gastrointestinal UnitL. Sacco HospitalMilanItaly

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