PREVENTION OF DUODENAL-ULCER RECURRENCE - A NEW PROSPECT

Prevention of recurrence is now the main therapeutic problem in the management of duodenal ulcer disease. It has been shown that in the absence of maintenance treatment the mean recurrence rate within 6 to 12 months from healing obtained with drugs other than H2-receptor antagonists (H2A) is lower than when healing is obtained with H2A. Possible reasons for this discrepancy are examined. When the recurrence rates observed with each of the non-H2A drugs were compared individually with those observed with H2A, the only important and constant difference was in favour of colloidal bismuth subcitrate (CBS). This beneficial effect of CBS is due to its bactericidal action on Helicobacter pylori. Unlike healing, prevention of recurrent ulcer is primarily, if not exclusively, related to eradication of this organism. Although the ideal treatment providing both healing of duodenal ulcers and eradication of Helicobacter pylori has not yet been determined (CBS administered alone eradicates this organism in only 10 to 25 percent of cases), it will soon be possible to modify dramatically the natural course of duodenal ulcer disease and even to obtain its cure.