The long-term treatment of peptic ulcer after a bleeding episode.

We have studied 51 consecutive patients bleeding from peptic ulcer which was duodenal (D.U.) in 30, gastric in 17 (G.U.), anastomotic in 3 (Billroth 2), and oesophageal in 1 of them. One patient with G.U. was sent for surgery and 2 patients with D.U. died early; the others recovered through medical treatment and the ulcer healed after 6-8 weeks of treatment with ranitidine in 46 out of 48 patients. Subsequently, all the healed patients have been treated with ranitidine (150 mg at bedtime) for 6 months; by this time a new endoscopy showed an erosive antral gastritis in 2 patients with G.U. and 2 recurrences of D.U. Then the patients and their family doctors were invited to choose between the interruption of the treatment and its prolongation. 8 patients with previous G.U. preferred to stop treatment, and up to 1-2 years they did not show any recurrence; the remaining 5 patients carried on the maintenance treatment, and up to one year one of them showed an erosive antral gastritis. 15 patients with previous D.U. stopped the treatment and 5 of them after 1-24 months presented a recurrence with a new haemorrhage; 8 patients chose to continue the treatment and none of them for 6-24 months had recurrence. The limited number of the patients obviously does not allow a sound conclusion, but a trend is clearly seen which favours a prolonged maintenance treatment in patients with D.U. which has bled.