Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease.
BACKGROUND
We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing.


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. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated.


RESULTS
Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group.


CONCLUSIONS
Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.
Graham
D Y
DY
Dept. of Medicine, Baylor College of Medicine, Houston, Texas.
Hepps
K S
KS
Ramirez
F C
FC
Lew
G M
GM
Saeed
Z A
ZA
D000328:Adult; D000368:Aged; D001729:Bismuth / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000382:microbiology / Q000517:prevention & control*; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D011899:Ranitidine / Q000627:therapeutic use*; D012008:Recurrence; D012459:Salicylates / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use*
D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D011899:Ranitidine; D013752:Tetracycline; D001729:Bismuth