Silent peptic ulceration: deadly silence or golden silence?

Peptic ulcer hemorrhage or perforation occur commonly in patients with hitherto silent ulceration, particularly in the elderly or in those taking nonsteroidal antiinflammatory drugs. The majority of patients dying from peptic ulceration have no symptoms of ulcer disease until the presentation of their final, fatal illness. There is a need for more studies investigating the early symptoms of the fatal ulcer disease, the effects of therapies that may prevent fatalities, and the management of potentially lethal ulcer disease upon clinical presentation. Silent ulceration also occurs in patients after successful healing with medical treatment, and the apparent point prevalence of silent ulceration (in the framework of a clinical trial) is critically dependent on the frequency of repeat endoscopic examination and the treatment modality. Maintenance treatment with H2-receptor antagonists appears to some extent to decrease the frequency of asymptomatic ulcers, but more interestingly to halt the progression of asymptomatic ulcers toward symptomatic or complicated ulceration, although more careful studies in comparison with other modalities are needed.