H2-blockers: how safe and how effective?

Worldwide clinical experience has shown the short-term use of H2-blockers is safe and effective. They speed the healing of acute endoscopically proven duodenal ulcer with few important side effects. Curious differences in placebo response and reported efficacy from country to country deserve explanation, but do not blur the overall benefit from H2-blockers or the general satisfaction of patients and physicians. While it seems likely that a concerned physician and a dedicated patient could achieve the same results without such therapy, the major clinical advantage of H2-blockers lies in the speed and ease with which they relieve symptoms and hasten healing of the ulcer crater. Indeed, it could be argued that such therapy should not be restricted to the patient with a "proven" duodenal ulcer, and that patients with symptoms who might have "Moynihan's disease" (dyspepsia without a crater) deserve therapy without further diagnostic endeavors. Long-term therapy is still under judgment for both safety and efficacy. Controlled clinical trials suggest that H2-blockers prevent the recurrence of endoscopically proven duodenal ulcer at an impressive rate, while the recurrence rate of duodenal ulcer in patients taking placebo has been appalling. Many thoughtful physicians now argue that the patient with a duodenal ulcer ought to remain on maintenance therapy after the ulcer has healed. There is a problem, however, in the "selection" bias of the controlled trial; only patients with a proven ulcer crater have been entered into such studies and therefore they represent a subset, however important, of patients with dyspepsia and peptic ulcer symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)