Although the approved indications for long-term
histamine (H2) receptor-antagonists are limited to the management of hypersecretory states and prophylaxis against recurrent
duodenal ulcer, these agents are often prescribed indiscriminately. Definitive guidelines concerning proper patient selection for prophylaxis against
duodenal ulcer recurrence are lacking. Persons likely to benefit from maintenance
therapy include those who
smoke and those with a long duration of symptoms or prior history of an
ulcer complication. Although not an approved indication, maintenance
therapy to prevent recurrent
gastric ulcer is appropriate for elderly persons receiving nonsteroidal anti-inflammatory drugs or in patients with poor cardiopulmonary status who may not tolerate surgery for an
ulcer-related complication. The role of long-term H2-antagonist
therapy in
reflux esophagitis is not defined but may be appropriate in scleroderma and
Barrett's esophagus. Finally, several miscellaneous conditions, including
cystic fibrosis,
Menetrier's disease, and pancreatic exocrine insufficiency, may benefit from long-term H2-antagonist
therapy. Currently, clinical trials document the efficacy of maintenance
therapy in
duodenal ulcer for up to a three-year period; however, for
gastric ulcer and chronic
reflux esophagitis, the duration and benefit of long-term
therapy is not established, and treatment regimens need to be individualized.
Therapy may be required indefinitely in the miscellaneous states mentioned previously.