Prevention of Ulcer Recurrence—Medical vs Surgical Treatment the Physician's View

Abstract

What factors should be considered in the choice between medical and surgical treatment of peptic ulcer disease? We would suggest the factors included in Table I. It is our opinion that we have concentrated too much on the recurrence rate, that is on how many of the patients who have a recurrence and not so much on the severity of recurrences in terms of symptoms, duration and influence on ability to work. It is also our firm belief that with regard to costs too much attention has been paid to one small part of the total cost, namely the cost for drugs.

The strategy in the choice of the treatment for patients with a peptic ulcer depends on many factors as shown in Table II. At our department, the pharmacological part of the treatment of the first episode of an active duodenal ulcer as well as the first recurrences will usually consist of cimetidine 800 mg as a single nocturnal dose or in divided doses, for 4–6 weeks. Antacids are often given for relief of pain. The treatment will be continued for another 2 weeks if the patient is not symptomless after 4 weeks. The patient is then instructed to make further contact in the event of new symptoms suggesting a recurrence. Personally, we usually perform another endoscopy at that time as a guidance for the decision whether to give maintenance treatment or not. If we find an ulcer or signs of duodenitis, we give another 4–6 weeks course of cimetidine. After two or more rapid relapses, or after relapses with severe symptoms, we have to choose between the following alternatives:

1. intermittent treatment with histamine₂-receptor antagonists

2. maintenance treatment with histamine₂-receptor antagonists

3. parietal cell vagotomy or selective vagotomy and antrectomy