Medical treatment of peptic ulcer disease.

Only a decade ago surgery was the preferred treatment of recurrent peptic ulcer. With the introduction of cimetidine in 1976 effective and safe medical treatment could be offered to the patient. H2-receptor antagonists are still the basic drugs in ulcer healing, but in recent years mucosa protective agents as sucralfate and colloidal bismuth have been increasingly used. Complete inhibition of acid secretion may be achieved by the new proton pump inhibitor omeprazole. In ulcer resistant to treatment with H2-receptor antagonists either a mucosa protective agent, as colloidal bismuth or a potent acid inhibitor (omeprazole) may be used. In recurrent duodenal ulcer a systematic and prolonged maintenance therapy with H2-receptor antagonists is indicated. This treatment is safe and it reduces the incidence of a relapse to one third compared with placebo. Surgery is no longer indicated in the majority of patients with uncomplicated recurrent peptic ulcer. In most patients this disease can now be controlled by effective and cheap anti-ulcer drugs. Although medical treatment of peptic ulcer has been used for centuries, surgery was still the main treatment of recurrent peptic ulcer in the nineteen seventies. Up to that time the surgical management of ulcer disease had made major progress, while medical treatment had failed to offer effective cure. Thus, as late as in 1975 the medical treatment of peptic ulcer consisted of antacids, bed rest and carbenoxolone. With the important side effects of carbenoxolone in mind, it is no wonder that medical treatment was no alternative to surgery in patients suffering from recurrent peptic ulcer.(ABSTRACT TRUNCATED AT 250 WORDS)