Therapeutic failure and relapse in peptic ulcer.

The objective of peptic ulcer (PU) treatment is to cure the ulcer, as no therapy exists for the disease itself. However, not all patients can be cured. The causes of therapeutic failure are not precisely known, and there is no easy way to identify failure-prone cases before commencing treatment. It is known that such patients do not show different gastric acid secretion patterns or alterations in drug absorption. Nevertheless, the inhibition achieved in nocturnal secretion is less than in patients who respond favorably to treatment. The therapeutic strategy to be followed has not been clearly defined, although a number of observations are of practical interest in designing therapeutic protocols. An increase in the doses of H2-antagonists administered is unable to enhance the antisecretory effect or improve the cure rate. On the other hand, prolonging the administration of the same or a different H2-antagonist is capable of curing many patients, but not all. Recently, it has been found that prolonging treatment with cytoprotective drugs would be more advantageous. This suggests that an alteration in the defensive mechanisms of the gastric mucosa may be the main cause of PU among these patients. In contrast, it has also been found that healing is practically universal on administration of a more potent antisecretory drug such as omeprazole. These observations suggest that a bivalent drug combining antisecretory and cytoprotective effects could reduce the number of failures; nevertheless, the ideal objective would be to treat the disease itself and not just the ulcer.