Five-year maintenance treatment with ranitidine: effects on the natural history of duodenal ulcer disease.

In this study, we assessed the effect of a 5-yr maintenance program with ranitidine on the natural history of duodenal ulcer disease both during treatment and after drug withdrawal. Two groups of patients with duodenal ulcer were studied. In group A patients (n = 40), ranitidine (150 mg/day) was given continuously for 5 yr; group B patients (n = 40), received seasonal, 8-wk prophylactic treatment with ranitidine (300 mg/day), in spring and fall. Routine endoscopy was performed every year and whenever ulcer symptoms recurred. After the 5-yr study, the drug was discontinued in both groups, and patients underwent endoscopy after 3, 6, 12, and 18 months. The probability of duodenal ulcer recurrence was significantly lower in patients continuously receiving ranitidine (p < 0.001), and ulcer complications were significantly lesser in group A patients (p < 0.03). In the 18 months of follow-up after drug discontinuation, only 15% (4/26) of patients of group A relapsed, whereas ulcer recurrence was diagnosed in 84% (26/32) of group B patients (p < 0.001). We conclude that low-dose continuous treatment with ranitidine is preferable to seasonal prophylaxis for its ability to modify the natural history of duodenal ulcer disease.