title: One-week antibiotics versus maintenance acid suppression therapy for Helicobacter pylori-associated peptic ulcer bleeding.
abstract: Bleeding peptic ulcer is the most important cause of upper gastrointestinal bleeding. Our aim was to compare the effect of anti-Helicobacter therapy with maintenance treatment of H2-receptor antagonist in the prevention of relapses of ulcer and bleeding. Patients with bleeding duodenal or gastric ulcers and H. pylori infection were randomized to receive either a one-week course of triple therapy with bismuth subcitrate, metronidazole, and tetracycline plus ranitidine or a six-week course of ranitidine 300 mg/day. After the ulcers healed, the antibiotic-treated patients were not given any medication, whereas the ranitidine-treated patients continued to receive a maintenance dose of 150 mg/day. One hundred twenty-six patients were randomized to receive anti-Helicobacter therapy and 124 patients to receive long-term ranitidine. H. pylori eradication was achieved in 98.2% in those who received triple therapy and 6.1% in those who received ranitidine (P < 0.0001). At the six-week follow-up, ulcer healing was documented in 88.2% in those who received triple therapy and 86.1% in those who received ranitidine (P = 0.639). Recurrent ulcer developed in nine of the ranitidine-treated patients and three of them presented with recurrent upper gastrointestinal bleeding. One patient in the antibiotic group developed recurrent ulcer without rebleeding (P = 0.01). It is concluded that eradication of H. pylori is sufficient for the prevention of recurrent bleeding ulcers.
authors.affiliation: Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sung
authors.forename: W K
authors.initials: WK
authors.lastname: Leung
authors.forename: R
authors.initials: R
authors.lastname: Suen
authors.forename: V K
authors.initials: VK
authors.lastname: Leung
authors.forename: F K
authors.initials: FK
authors.lastname: Chan
authors.forename: T K
authors.initials: TK
authors.lastname: Ling
authors.forename: J Y
authors.initials: JY
authors.lastname: Lau
authors.forename: Y T
authors.initials: YT
authors.lastname: Lee
authors.forename: E K
authors.initials: EK
authors.lastname: Ng
authors.forename: A F
authors.initials: AF
authors.lastname: Cheng
authors.forename: S C
authors.initials: SC
authors.lastname: Chung
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001729:Bismuth / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy*; D011899:Ranitidine / Q000008:administration & dosage*; D012008:Recurrence; D013752:Tetracycline / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D008795:Metronidazole; D011899:Ranitidine; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D001729:Bismuth