The Fate of Asymptomatic Recurrences of Duodenal Ulcer

Abstract

Thirty-six patients in whom an asymptomatic duodenal ulcer had been detected endoscopically were followed up clinically and endoscopically during the following months. Ten of the patients were receiving either no treatment or placebo, and 26 patients were receiving maintenance treatment with either 150 mg ranitidine or 400 mg cimetidine at night. Treatment remained unchanged during the follow-up period. The cumulative annual rate of spontaneous healing was approximately one quarter, whether or not patients were receiving active maintenance therapy. However, the likelihood of developing symptoms during the year after detection of the asymptomatic ulcer was significantly greater in those patients receiving no treatment or placebo (77%) than in those receiving active maintenance therapy (27%). One patient, receiving no treatment, bled from his ulcer during the follow-up period. We conclude that routine endoscopic reexamination, to detect asymptomatic ulcer recurrences in patients receiving maintenance treatment for duodenal ulceration, is probably unnecessary, since the recurrences rarely cause clinical problems, despite prolonged failure to heal.

Maintenance Therapy of Duodenal and Gastric Ulcer with H2-Receptor Antagonists

“…Follow-up studies of asymptomatic ulcers in patients receiving maintenance therapy have demonstrated that such ulcers rarely cause clinical problems-each month during continued maintenance therapy approximately 33% reheal, 61% remain unchanged, and only 6 % give rise to symptoms (35). Similar findings have been reported previously (37) and were also observed in an unreported maintenance study with full-dose ranitidine (referred to above) in which all patients were endoscopically examined after 2, 4, 8, 12, and 16 weeks of maintenance therapy. These findings suggest that it is unnecessary t o attempt to diagnose and reheal asymptomatic ulcers in patients receiving maintenance therapy with H2receptor antagonists.…”

Maintenance Treatment with Cimetidine in Peptic Ulcer Disease for Up to 4 Years

“…Clinical data (8) indicate that asymptomatic relapses during active maintenance therapy are clinically benign, since such ulcers rarely give rise to complications. Therefore, all further evaluation of the data has been based only on ulcer recurrences with typical ulcer symptoms or complications of the disease.…”

Management of Patients with Rebleeding

“…Early studies before the discovery of H pylori and proton-pump inhibitor reported relapse rates of up to 74% during a 12-month follow-up period. 73,74 Approximately 25% to 40% of the ulcer recurrences were asymptomatic, 75,76 whereas others may present with rebleeding. 77,78 Definitive treatment and preventive measures are required to reduce ulcer recurrence and its complications.…”

“…[73][74][75][76] It is, therefore, important to ensure complete eradication of the bacterium. An early study comparing eradication therapy (bismuth, metronidazole, and tetracycline) with acid-suppression therapy (omeprazole) showed similar rates of gastric ulcer healing but a significantly lower rate of ulcer recurrence in the eradication group (4.5% vs 53.2%, P<.01).…”