Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study.
OBJECTIVE
To determine the effect of treating Helicobacter pylori infection on the recurrence of gastric and duodenal ulcer disease.


METHODS
Follow-up of up to 2 years in patients with healed ulcers who had participated in randomized, controlled trials.


METHODS
A Veterans Affairs hospital.


METHODS
A total of 109 patients infected with H. pylori who had a recently healed duodenal (83 patients) or gastric ulcer (26 patients) as confirmed by endoscopy.


METHODS
Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet) and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given.


METHODS
Endoscopy to assess ulcer recurrence was done at 3-month intervals or when a patient developed symptoms, for a maximum of 2 years.


RESULTS
The probability of recurrence for patients who received triple therapy plus ranitidine was significantly lower than that for patients who received ranitidine alone: for patients with duodenal ulcer, 12% (95% CI, 1% to 24%) compared with 95% (CI, 84% to 100%); for patients with gastric ulcer, 13% (CI, 4% to 31%) compared with 74% (44% to 100%). Fifty percent of patients who received ranitidine alone for healing of duodenal or gastric ulcer had a relapse within 12 weeks of healing. Ulcer recurrence in the triple therapy group was related to the failure to eradicate H. pylori and to the use of nonsteroidal anti-inflammatory drugs.


CONCLUSIONS
Eradication of H. pylori infection markedly changes the natural history of peptic ulcer in patients with duodenal or gastric ulcer. Most peptic ulcers associated with H. pylori infection are curable.
Graham
D Y
DY
Baylor College of Medicine.
Lew
G M
GM
Klein
P D
PD
Evans
D G
DG
Evans
D J
DJ
Saeed
Z A
ZA
Malaty
H M
HM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001729:Bismuth; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D012459:Salicylates / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000188:drug therapy / Q000382:microbiology*; D013752:Tetracycline / Q000627:therapeutic use
D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D011899:Ranitidine; D013752:Tetracycline; D001729:Bismuth