Increased risk for Helicobacter pylori recurrence by continuous acid suppression: a randomized controlled study.
OBJECTIVE
Acid hyposecretion may enhance Helicobacter pylori colonization. We tested the hypothesis that maintenance therapy with ranitidine after cure of Helicobacter pylori infection increases the risk of recurrence of infection.


METHODS
Sixty-six patients with duodenal ulcer and cured Helicobacter pylori infection were randomly assigned to 12 months maintenance treatment with ranitidine 150 mg daily (group A) or no treatment (group B). Follow-up consisted of clinical and endoscopic controls with biopsies for histology and rapid urease test every 4 months.


RESULTS
Six patients, 3 in each group, were lost to follow up. Helicobacter pylori recurrence occurred in 9 patients in group A and in 2 patients in group B (30% versus 7%; p < 0.05). Duodenal ulcer recurred in one patient in group A and in 2 in group B, all three patients were reinfected with Helicobacter pylori. A corpus-predominant gastritis was observed in all reinfected patients in group A but in none in group B.


CONCLUSIONS
Long-term inhibition of gastric acid secretion after eradication of Helicobacter pylori increases the risk of recurrence of infection. Our data imply that gastric acid not only influences the pattern of Helicobacter pylori localization in gastric mucosa, but also plays a key role in preventing recurrence of infection with Helicobacter pylori.
Manes
G
G
Dipartimento di Gastroenterologia, Ospedale Cardarelli, Napoli, Italy.
Domínguez-Muñoz
J E
JE
Uomo
G
G
Labenz
J
J
Hackelsberger
A
A
Malfertheiner
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015169:Colony Count, Microbial; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism*; D005753:Gastric Mucosa / Q000187:drug effects* / Q000378:metabolism / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology*; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011899:Ranitidine / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors
D006635:Histamine H2 Antagonists; D011899:Ranitidine