Peptic ulcer: relapses were common

Clinical bottom line (level 4)

  1. A third of patients with healed peptic ulcers relapsed within the next year.
  2. Patients were at increased risk of having a relapse if they had
    • duodenal ulcers
    • psychological stress
    • scarring at the ulcer site
    • no medication to help healing
Ishimori et al: Hepato-Gastroenterology 1992; 39: 396-399
Expires October 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 47 acute hospitals, Japan

217 patients (aged , % male) with a recently-healed peptic ulcer

Excluded if
  • pregnant
  • aged > 70
  • not all prognostic factors used were evaluable
  • ulcer failed to heal within 3 months
Factors studied:
  • acute therapy, maintenance therapy, age, sex, inpatient status, history of ulcers, site of original ulcer, endoscopic findings, smoking, alcohol intake, diet, time spent sleeping, psychological stress


Patients continued on maintenance therapy of pirenzepine 75 mg daily for 12 months, and were allowed to take antacids and antispasmodics as required. Patients had routine endoscopy every 3 months.

Cox regression analysis performed on prognostic factors.

63% followed for 12 months
Outcomes studied:
  • relapse

  • Patients were part of a randomised trial comparing cimetidine and pirenzipine

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
relapse 12 months 79/217 36%
(30% to 43%)		 3
(2 to 3)

  • The following prognostic factors were independently associated with relapse
    • duodenal ulcer
    • psychological stress
    • endoscopic findings of scars at ulcer sites on healing
    • no acute therapy

Comments

  1. Significant loss to follow-up makes these results much less certain.

Citation

  1. Ishimori A, Kawakami K, Inoue S, et al: predictors of relapse in peptic ulcer. Hepato-Gastroenterology 1992; 39: 396-399
Contributor: Chris Ball and Martin Dawes, October 1999
Reviewer: Zoltan Bodnar

Clinical Question.
    Patient healed peptic ulcer
    Intervention or Exposure clinical and endoscopy features
    Outcome ulcer relapse