Quality of healing in peptic ulcer disease—are H2 receptor antagonists all we need?

Abstract

The rapid relief of symptoms and ulcer healing can now be achieved in most patients with peptic ulcer. Histamine2 (H2) receptor antagonists, proton pump inhibitors, prostaglandin analogues, colloidal bismuth and sucralfate have all proved safe and effective for the initial treatment of peptic ulcer. However, most ulcers will recur when treatment is stopped. Meta-analyses suggest a higher relapse rate after H2 antagonist therapy than that following sucralfate or bismuth. This difference has not been explained although improved morphology and/or functional status of the gastroduodenal mucosa ("quality of healing") has been claimed. Eradication of Helicobacter pylori leads to marked reduction in relapse rate but more effective and safer eradication regimens are needed. Since most ulcers do recur, maintenance therapy with H2 antagonists remains a commonly used option. Continuous maintenance results in low symptomatic relapse, complications occur rarely, and such treatment is safe. An alternative is Symptomatic Self Care (on-demand therapy) which provides an economic option for patients with no concomitant disease or previous complications. Future research should decide the exact role of Helicobacter eradication; but for now, we can still rely on maintenance therapy with the widely-used and proven H2 receptor antagonists.