Does maintenance therapy keep duodenal ulcers healed?

34 patients were endoscopically reexamined once a month while receiving ranitidine 150 mg at night to sustain remission of a duodenal ulcer. The cumulative recurrence rate after 1 year of maintenance treatment was 48%. 71% of recurrences were painless when first detected. The monthly percentage probabilities for asymptomatic ulcers rehealing, remaining unchanged, and causing pain were 33%, 63%, and 4%, respectively. Because painless ulcers may reheal, the number of ulcer recurrences detected during maintenance trials depends on the frequency of endoscopic reexamination of symptomless patients. Endoscopic examination of symptomless patients every 6 months would have failed to detect nearly half of all recurrences in this study. Thus an accurate assessment of the true incidence of asymptomatic (and, therefore, total) recurrences requires frequent endoscopic re-examination of symptomless patients. The clinical value of maintenance treatment should be judged by prevention of symptoms and complications, since it is not possible--either practically or mathematically--to determine the true incidence of ulcer recurrence, and because asymptomatic recurrences are irrelevant, provided maintenance treatment is continued.