Eradication of Helicobacter pylori for the prevention of peptic ulcer rebleeding.
OBJECTIVE
To evaluate the effect of Helicobacter pylori eradication on ulcer bleeding recurrence in a prospective, long-term study including more than 400 patients.


METHODS
Patients with peptic ulcer bleeding were prospectively included. H. pylori infection was confirmed by rapid urease test, histology or (13)C-urea breath test. Several eradication regimens were used. Ranitidine 150 mg was administered daily until eradication was confirmed by breath test 8 weeks after completing eradication therapy. Patients with therapy failure received a second or third course of therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy, and were controlled yearly with a repeated breath test.


RESULTS
Four hundred and twenty-two patients were followed up for at least 12 months, with a total of 906 patient-years of follow up. Mean age was 59 years, and 35% were previous nonsteroidal anti-inflammatory drug (NSAID) users. Sixty-nine percent had duodenal, 24% gastric, and 7% pyloric ulcer. Recurrence of bleeding was demonstrated in two patients at 1 year (incidence: 0.22% per patient-year of follow up), which occurred after NSAID use in both cases.


CONCLUSIONS
Peptic ulcer rebleeding does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved.
Gisbert
Javier P
JP
Department of Gastroenterology, Hospital de la Princesa, Madrid, Spain. gisbert@meditex.es
Calvet
Xavier
X
Feu
Faust
F
Bory
Felipe
F
Cosme
Angel
A
Almela
Pedro
P
Santolaria
Santos
S
Aznárez
Rosario
R
Castro
Manuel
M
Fernández
Nuria
N
García-Grávalos
Rafael
R
Cañete
Nuria
N
Benages
Adolfo
A
Montoro
Miguel
M
Borda
Fernando
F
Pérez-Aisa
Angeles
A
Piqué
Jose María
JM
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000658:Amoxicillin; D017291:Clarithromycin