Recurrent duodenal ulcers, treated with cimetidine, 400 mg, or ranitidine, 150 mg, once nightly, or with sucralfate, 1 g twice daily, can be prevented in approximately 75% of patients for up to 1 year. Because these drugs are generally of equal efficacy, the choice is based on the patient's previous drug experience and tolerance, potential side effects, risk of drug interaction, frequency of administration, and cost. These medications do not alter the natural history of duodenal ulcer disease, and therapy may need to continue for longer than 1 year if there are no long-term side effects. Extra efforts should be made to help cigarette smokers discontinue smoking. Patients who have recurrent duodenal ulcers during maintenance therapy can be retreated with full-dose therapy. If optimal drug therapy is unsuccessful in preventing frequent recurrences or complications, surgical treatment is indicated.