MAINTENANCE ULCER THERAPY CUT URGED

A team of UK gastroenterologists have called for physicians to stop treating duodenal ulcer patients with maintenance H2 antagonist therapy. Speaking at an Astra-sponsored conference in London, Rory McCloy, senior lecturer and honorary consultant surgeon at Manchester Royal Infirmary, said that the majority of patients did not relapse often enough in a year to justify this maintenance "overtreatment."

Overall, he said, about 25% of patients with a duodenal ulcer will not relapse within one year of initial healing. A third will have just one relapse, 25% will have two and just 17% will suffer from more than three recurrent ulcers per year. For this reason, Mr McCloy recommended that Astra's Losec proton pump inhibitor omeprazole should be used in the majority of patients as an intermittent therapy, managing the disease as and when symptoms present. Omeprazole is better than the H2 antagonists for intermittent therapy, he said, because of its short healing time and rapid symptom relief. The two most widely-used H2 antagonists in the UK are Glaxo's Zantac (ranitidine) and SmithKline Beecham's Tagamet (cimetidine).

Maintenance therapy, continued Mr McCloy, should only be used in patients who experience more than three episodes of duodenal ulcer a year, in the elderly, and in patients with a history of perforation and bleeding. Another problem with this approach is patient non-compliance, especially when they are not experiencing any symptoms.