Successful eradication of Helicobacter pylori prevents relapse of peptic ulcer disease.
BACKGROUND
The NIH consensus conference in 1994 recommended that all patients with peptic ulcers should be tested and treated for Helicobacter pylori. Recent studies have shown that the eradication of H. pylori is associated with a significant reduction in the relapse rate of peptic ulcers, but there are few reports about long-term outcome.


OBJECTIVE
To evaluate the relapse rate of peptic ulcer in the long-term follow-up of patients after H. pylori eradication therapy.


METHODS
Patients infected with H. pylori (445; 88 duodenal ulcer, 357 gastric ulcer) were randomly divided into three groups. In group A, patients received 'conventional treatment' including acid decreasing therapy with a histamine H2-receptor antagonist or proton pump inhibitor (PPI). In group B, patients received 'dual therapy' including one antibiotic plus acid-decreasing therapy. In group C, patients received 'triple therapy' with PPI plus amoxicillin and clarithromycin. Eradication of H. pylori infection was assessed by histology of biopsy specimens from both the antrum and body corpus at 4 weeks, and 6 and 12 months after stopping therapy. Endoscopy was performed at intervals of 6 months for 5 years.


RESULTS
Intention-to-treat eradication rates for the duodenal ulcer patients were 0% for group A, 46% for group B and 80% for group C; eradication rates for the gastric ulcer patients were 0%, 33% and 83% respectively. No recurrence was noted in the duodenal ulcer patients and only 4% of gastric ulcers recurred after successful eradication during follow-up for 5 years. In contrast, in patients with persistent H. pylori infection all DU and 92% of gastric ulcers recurred.


CONCLUSIONS
Eradication of H. pylori infection changes the natural course of peptic ulcer.
Tomita
T
T
Department of Gastroenterology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Fukuda
Y
Y
Tamura
K
K
Tanaka
J
J
Hida
N
N
Kosaka
T
T
Hori
K
K
Sakagami
T
T
Satomi
M
M
Shimoyama
T
T
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000209:etiology* / Q000517:prevention & control*; D054328:Proton Pump Inhibitors; D055502:Secondary Prevention; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors