Ulcer Treatment–Regimens and Duration of Inhibition of Acid Secretion: How Long to Dose

Abstract

The healing rate of duodenal and gastric ulcer depends on the duration of treatment. When a single drug is examined, there are considerable variations from study to study. The healing rate also depends on the type of drug used. It increases with an increasing degree of acid inhibition. Thus, the strongest acid inhibitor presently known, omeprazole, leads in patients with duodenal ulcer to 2-week healing rates of 65%, similar to the 4-week healing rate observed with H₂-antagonists. If the aim is, however, to heal almost all ulcers at risk, then treatment should last for 4 weeks with omeprazole and 6 weeks with H₂-antagonists. It has been claimed that eradication of Campylobacter pylori accelerates ulcer healing, but this is at present controversial. The duration of treatment depends on whether an endoscopy is performed at the end of treatment and on the presence or absence or risk factors. Treatment of duodenal ulcer should last 6 weeks with H₂-antagonists or 4 weeks with omeprazole when no endoscopy is performed at the end of treatment or if two of the following risk factors are present: ulcer larger than 1.5 cm, smoking, psychologic stress, and slow healing in the past. If only one or none of the risk factors is present and if endoscopy is performed, ulcer treatment may last for only 4 weeks with H₂-antagonists or 2 weeks with omeprazole. In gastric ulcer, in which endoscopy at the end of treatment is obligatory, treatment depends on ulcer size. Thus it should last for 4 weeks if the ulcer is smaller than 1.5 cm and for 6 weeks if the ulcer is larger. Neither in gastric nor in duodenal ulcer is it recommended to determine the duration of treatment on the basis of symptoms, because symptoms and healing show poor correlation. However, symptoms at the end of treatment should lead to an endoscopy and might thus lead to a prolongation of treatment. Maintenance treatment with H₂-antagonists reduces both symptomatic and asymptomatic recurrences and may also reduce the risk of hemorrhage. It is still undecided whether maintenance treatment favors the development of malignancies. On the assumption that the conditions of maintenance treatment are similar to those after proximal gastric vagotomy, it is likely that this risk is small. Most ulcer attacks can be efficiently treated with omeprazole, and the recurrence rate may be lowered by eradication of C. pylori. Thus, maintenance treatment with acid-reducing drugs should only be given to patients in whom recurrence is to be avoided at all costs because they are either highly symptomatic or at the risk of developing a life-threatening ulcer complication.

Key Words:

• Duodenal ulcer
• duration of treatment
• gastric ulcer
• ulcer healing
• ulcer relapse