Does long-term maintenance therapy with ranitidine affect the natural course of duodenal ulcer disease?

Objective: To study the course of chronic duodenal ulcer disease and the influence of risk factors on duodenal ulcer relapse after 2 years of maintenance treatment. Design: Prospective multicentre 1-year follow-up study in outpatients. Patients: Nine hundred and sixty-four patients with chronic duodenal ulcerations who had completed 2 years of maintenance treatment (ranitidine 150 mg daily). Main outcome measures: Duodenal ulcer relapse rate. Results: During the 1-year follow-up, 233 patients continued and 731 discontinued maintenance treatment During this period, 27.7 relapses/100 patients per year [95% confidence interval (Q) 24.9–30.5] occurred compared with 169.4 relapses/100 patients per year (95% Cl 144–196) before and 7.7 (95% Cl 6.2–9.7) symptomatic and 2.2 (95% Cl 1.3–3.3) asymptomatic relapses/100 patients per year during the 2 years of maintenance treatment The relapse rate in patients on maintenance treatment during follow-up (14.2 relapse/100 patients per year, 95% Cl 9.7–18.6) was significantly lower than in those without maintenance treatment (32.0 relapses/100 patients per year, 95% Cl 28.6–35.4, P < 0.001). The proportion of patients who relapsed during the first 2 years of maintenance treatment was higher in patients who continued (21%, 95% Cl 15.8–26.3) than in those who discontinued maintenance treatment during follow-up (14.9%, 95% Cl 12.3–17.5, P < 0.01). Patients who relapsed during the first 2 years of maintenance therapy had an increased relapse risk during follow-up (odds ratio 2.43, 95% Cl 1.93–3.05, P Conclusion: Maintenance therapy with ranitidine for more than 2 years prevents duodenal ulcer relapse. Cessation of maintenance treatment increases relapse rates which, however, remain markedly lower than those seen prior to maintenance therapy.