title: Peptic ulcer recurrence during maintenance therapy with H2-receptor antagonist following first-line therapy with proton pump inhibitor.
abstract: We investigated the peptic ulcer recurrence rates during maintenance therapy with H2-receptor antagonists (H2RAs) following first-line therapy with a proton pump inhibitor (PPI). Patients with gastric ulcer (GU) or duodenal ulcer (DU) were enrolled in this study; 583 eligible patients (GU, 325; DU, 258) were administered lansoprazole (30 mg/day for 8 weeks for GU, and the same dosage for 6 weeks for DU) as first-line therapy, and a half dose of H2RA as maintenance therapy for 12 months. Endoscopic photographs were taken before administration and after 8 (GU) and 6 (DU) weeks of lansoprazole administration. Ulcer stage was evaluated using the classification of Sakita and Miwa. Endoscopic examinations were performed 6 months or 12 months after the start of maintenance therapy or when a recurrence was suspected because of the appearance of subjective symptoms. The healing rates for GU and DU patients after completion of lansoprazole therapy were 79% in both groups, while the S2-stage healing rates were 18% and 31%, respectively. At 1 year after the start of maintenance therapy, the recurrence rates were 25% for GU and 39% for DU patients. In DU patients, the recurrence rates from S1-stage and S2-stage were 49% and 20%, respectively (P = 0.004), but no significant difference was found between these rates in GU patients. The recurrence rates in H. pylori-positive patients before lansoprazole administration were 27% for GU and 43% for DU patients. We concluded that the maintenance therapy with a half-dose of H2RA following PPI therapy was insufficient to prevent recurrences of GU and DU.
authors.affiliation: Hamamatsu University School of Medicine, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Kaneko
authors.forename: Y
authors.initials: Y
authors.lastname: Hoshihara
authors.forename: N
authors.initials: N
authors.lastname: Sakaki
authors.forename: S
authors.initials: S
authors.lastname: Harasawa
authors.forename: K
authors.initials: K
authors.lastname: Ashida
authors.forename: M
authors.initials: M
authors.lastname: Asaka
authors.forename: S
authors.initials: S
authors.lastname: Asaki
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: G
authors.initials: G
authors.lastname: Kajiyama
authors.forename: N
authors.initials: N
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Yao
authors.forename: Y
authors.initials: Y
authors.lastname: Muto
authors.forename: S
authors.initials: S
authors.lastname: Nakazawa
authors.forename: T
authors.initials: T
authors.lastname: Takemoto
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D012008:Recurrence; D013276:Stomach Ulcer / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole