Duodenal Ulcer Therapy, “Acid Rebound,” and Early Relapse

It is generally accepted that duodenal ulcers (DU) recur within a year in 75-90% of patients following healing with an HZ-receptor antagonist (H2RA). Relapse rates following initial treatment with colloidal bismuth agents are appreciably, and often significantly, lower than those following initial treatment with an H2RA, and a similar short-term advantage has been reported in most 3- to 6-month follow-up studies in patients healed initially with sucralfate. The reason for the trend toward lower relapse rates following ulcer healing with mucosal protective agents is not clear. Attention has been drawn to differences in the quality of ulcer healing following treatment with an H2RA and the mucosal protective agents, and the antimicrobial effect of colloidal bismuth agents against H. pylori-and the possible effect of sucralfate on these organisms is clearly pertinent. A third possibility relates to the concept of increased parietal cell sensitivity following treatment with an H2RA. This review will focus on acid secretory changes following DU healing with sucralfate and H2RAs, and an attempt will be made to link these with the liability to early relapse.