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Long-term cimetidine for duodenal ulceration?


Duodenal ulceration is a chronic disease in which patients relapse with varying frequency over perhaps 10 years or so.1 Although about 70% of ulcers heal on cimetidine 1 g/day given for four to six weeks, such short-term treatment does not alter the subsequent natural history of the illness.2–4 About 65% of patients relapse within one year of stopping cimetidine as judged on symptoms alone,2 and about 80% do so if the assessment includes regular endoscopy.5 It is not yet known whether the maintenance of endoscopic, as opposed to symptomatic, remission is important, nor whether it is practicable, but it might prevent complications in patients who have already suffered a perforation or haemorrhage. The frequency of relapses cannot however be predicted. If cimetidine is to be used in the long term what regimen should be recommended? Two have been tried: (1) to give it continuously in a smaller dose to try to prevent relapse (maintenance therapy); (2) to give the standard dose for four to six weeks for each relapse and then stop (intermittent therapy).

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