title: Helicobacter pylori and refractory duodenal ulcers: cross-over comparison of continued cimetidine with cimetidine plus antimicrobials.
abstract: OBJECTIVE
  To determine the distribution of Helicobacter pylori in the antral and duodenal mucosa of patients with duodenal ulcers refractory to 12 wk of treatment with cimetidine and to evaluate the effect of adding antimicrobial agents to cimetidine on the healing of refractory duodenal ulcers.
  
  
  METHODS
  A randomized crossover comparison of continued 800 mg of cimetidine at night for 4 wk with cimetidine plus 500 mg of amoxycillin three times a day for the first 2 wk and 250 mg of metronidazole three times a day for the second 2 wk. H. pylori status in the gastric antral and duodenal mucosa was evaluated by histology and bacterial culture before and at the end of each treatment period.
  
  
  RESULTS
  Forty-eight patients were studied. Upon entry to the study, all patients had antral colonization with H. pylori. In the duodenum, active chronic duodenitis was present in 66%, duodenal gastric metaplasia in 33%, and H. pylori in 50%, similar proportions to patients with nonrefractory duodenal ulcers. Healing occurred in 70% (30 of 43) of patients during treatment with cimetidine plus antimicrobials but in only 21% (6 of 28) during treatment with cimetidine alone (p = 0.0003). In patients who received antimicrobials, neither clearance of H. pylori from the antrum (58% of patients) or duodenum (71% of colonized patients) nor eradication of H. pylori (33%) was significantly correlated with ulcer healing.
  
  
  CONCLUSIONS
  The distribution of H. pylori in refractory duodenal ulcers is similar to nonrefractory ulcers, and the combination of amoxycillin and metronidazole with cimetidine increases the proportion of refractory duodenal ulcers, which heals.
authors.affiliation: Disciplina de Gastroenterologia Clinica, Faculdade de Medicina, Universidade de Sao Paulo, Brasil.
authors.forename: H K
authors.initials: HK
authors.lastname: Boyd
authors.forename: S
authors.initials: S
authors.lastname: Zaterka
authors.forename: J N
authors.initials: JN
authors.lastname: Eisig
authors.forename: D
authors.initials: D
authors.lastname: Chinzon
authors.forename: K
authors.initials: K
authors.lastname: Iriya
authors.forename: A A
authors.initials: AA
authors.lastname: Laudanna
authors.forename: E J
authors.initials: EJ
authors.lastname: Boyd
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use*; D002927:Cimetidine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D008795:Metronidazole; D002927:Cimetidine; D000658:Amoxicillin