Management of duodenal ulcer disease in the era of H. pylori.
BACKGROUND
Today it is expected that the great majority of patients with duodenal ulcer (DU) respond to H. pylori eradication treatment without DU recurrence. The aim of the research is to identify patients who need a different therapeutic approach and the best management of their disease.


METHODS
We examined retrospectively the medical history of 474 patients (326 males, mean age 61 years), followed up in 5 years in the outpatients department of a third level GI Center. From our research, 5 subgroups of patients emerged: 1) 63.5% carrying H. pylori infection, with successful eradication treatment and without DU recurrence; 2) 4% failing 3 courses of H.pylori eradication treatment; 3) 11% with DU lacking evidence of H. pylori infection or relapsing after verified eradication; 4) 8% being treated with NSAIDs; 5) 13% with DU complicated by hemorrhage or perforation.


RESULTS
23% of patients with DU need long-term therapy after H. pylori eradication treatment. Concerning this, the percentage of ulcerous recurrences in patients receiving anti-H2 therapy is 18.5%, but decreases considerably to 2% when PPI were used.


CONCLUSIONS
Although representing the mainstay of DU therapy, H. pylori eradication treatment may not abolish all issue in DU management. Actually, of DU patients referred to a third level GI Center, 23% need a different therapeutic approach, which results from a thorough analysis of the medical history of the patient.
Vanni
E
E
Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Molinette Hospital, Turin.
Pellicano
R
R
Demarchi
B
B
Gardino
L
L
Palmas
P
P
Arena
V
V
Cossotto
D
D
Leone
N
N
Rizzetto
M
M
Ponzetto
A
A
Palmas
F
F