Effects of treatment compliance and overnight gastric secretion on outcome of maintenance therapy of duodenal ulcer with ranitidine.

Eighty-seven patients with endoscopically healed duodenal ulcers received continuous maintenance treatment with a standard dose of 150 mg ranitidine at night for 6-12 months. The cumulative annual rate of symptomatic reulceration was 24%, whereas a further 25% of asymptomatic relapses were detected with routine endoscopic examination. Compliance with drug therapy was assessed by urinalysis for ranitidine and by returned tablet count. Urinalysis appeared to provide the more accurate index of drug intake. Compliance was similar in patients whose ulcers remained healed after 1 year's treatment and in patients with asymptomatic recurrence. Patients who developed symptomatic recurrences showed significantly poorer compliance in the period before development of symptoms. Overnight secretion of acid and pepsin during treatment did not differ between patients whose ulcers remained healed and those with relapses. Poor compliance was not implicated in the development of recurrence in patients who had good inhibition of overnight gastric secretion. We conclude that duodenal ulceration can recur during nocturnal maintenance treatment despite good compliance and satisfactory inhibition of nocturnal gastric secretion. However, symptomatic manifestation of the recurrences reflects poor compliance with treatment.