[A trial of modified triple therapy for the eradication of H. pylori in recurrent duodenal ulcer].
In a prospective trial we examined the efficacy and acceptability of a modified triple therapy in H. pylori (HP)-positive patients with recurrent duodenal ulcer disease. Oral administration of amoxicillin for two weeks was substituted for one single injection of intramuscular depot penicillin (benzathine penicillin G). Additionally, patients were given ornidazole 500 mg tid for 14 days and 120 mg colloidal bismuth sub-citrate qid for 28 days. The patients were investigated for H. pylori colonization using a rapid urease test (CLO), histology (H&E-, Giemsa stain), culture (including determination of the minimal inhibitory concentrations for metronidazole, penicillin G and amoxicillin) and H. pylori serology (Cobas Core Anti-H. pylori EIA, F. Hoffmann-La Roche). Control endoscopies using the same methods were performed 1 and 6 months after eradication therapy. The eradication rate was 50% and the ulcer healing rate 90% 1 month after therapy. Ulcers recurred in 2/3 of patients with persistent infection vs 0/5 of HP-eradicated patients after 6 months. Both successfully HP-eradicated patients and patients with treatment failure exhibited comparable decreases in mean serum IgG anti-HP concentration within 2 months. Discrimination between the two groups and hence identification of the eradication success by serology was not possible within a time period of 2 months. After 6 months, serum IgG anti-HP concentrations in non-HP-eradicated patients returned to pre-therapy values, in HP-eradicated patients the concentrations further decreased. The above-described modified triple therapy against HP cannot be recommended as a standard therapy, mainly because of the insufficient eradication effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Wirth
H P
HP
Departement für Innere Medizin, Abteilung für Gastroenterologie, Universitätsspital Zürich.
Wüst
J
J
Flury
R
R
Zala
G
G
Casanova
C
C
Bertschinger
P
P
Ammann
R
R
Münch
R
R
D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001729:Bismuth / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D009950:Ornidazole / Q000008:administration & dosage*; D010401:Penicillin G Benzathine / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence
D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D009950:Ornidazole; C002791:bismuth tripotassium dicitrate; D010401:Penicillin G Benzathine; D001729:Bismuth
Versuch einer modifizierten Tripeltherapie zur H.-pylori-Eradikation bei rezidivierendem Ulcus duodeni.