Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection.

Joachim Labenz, Gereon BörschAmerican Journal of Gastroenterology 89 (10), 1994Abstract in a cohort of 190 patients, before and up to 4 yr after eradication of Helicobacter pylori infection.

Methods:

190 patients with recurrent and/or complicated H. pylori-positive peptic ulcer disease (duodenal ulcer, n= 124; gastric ulcer, n= 59; gastroduodenal double ulcer, n= 2; anastomotic ulcer after partial gastric resection, n= 5) were prospectively followed up to 4 yr after eradication of H. pylori. Patients were investigated clinically and endoscopically, including the assessment of H. pylori infection before treatment, 4 wk after cessation of the eradication therapy, in 1-yr intervals and when symptoms of the ulcer disease recurred.

Results:

Cure of H. pylori infection was obtained by either omeprazole plus amoxicillin (n= 157) or oral triple therapy (n= 33). The overall ulcer relapse rate was 0.9% per patient year. Comparing the pre-and postherapeutical course of the disease, the 1-yr ulcer recurrence rate decreased from 67.9% to 1.1%(P < 0.0001), and the 2-yr relapse rate decreased from 91.1% to approximately 3.0%(calculation: 0.9% ulcer recurrences per patient year x 329 patient years)(P < 0.0001) without relevant differences between the two major groups of patients with either duodenal or gastric manifestation of their ulcer disease. Ulcer complications did not occur. The H. pylori recurrence rate was 2.6% in the 1st and 1.2% in the 2nd yr after eradication. In the 3rd and 4th yr, no H. pylori reinfections were detected.

Conclusion:

Cure of H. pylori infection was associated with a highly significant change of the disease history in this large group of patients with formerly relapsing and/or complicated peptic ulcers. In addition, H. pylori eradication is a stable phenomenon at least during the first 4 yr after treatment. Thus, H. pylori eradication should be considered in those patients with peptic ulcer disease severe enough to require avoidance of ulcer recurrence or its complications.View at search.ebscohost.com

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Low dose, short-term triple therapy for cure of Helicobacter pylori infection and healing of peptic ulcers.

Bernhard H Jaup, Anders NorrbyAmerican Journal of Gastroenterology 90 (6), 1995Objectives: The aim of this study was to confirm the efficacy and tolerability of a new, low dose, short-term triple therapy for cure of Helicobacter pylori infection, as suggested by Bazzoli, in a larger population. Methods: On an” intention-to-treat” basis, 116 patients with active (n= 41) or healed (n= 47) peptic ulcer disease or ulcer-like dyspepsia (n= 28) and H. pylori infection received a 1-wk course of omeprazole 20 mg bid , clarythromycin 250 mg bid , and tinidazole 500 mg bid , Four weeks after treatment withdrawal, cure of H. pylori infection was evaluated by rapid urease test and histology. Results: One hundred and sixteen patients returned for follow-up. In 108 patients, H. pylori could not be identified 4 wk after cessation of therapy. The eradication rate was calculated to 93%. In addition, all patients with active peptic ulcers showed complete healing at follow-up despite no further treatment. Drug acceptance and compliance was excellent. Conclusion: Triple therapy as suggested by Bazzoli with omeprazole (in this study given bid for better compliance), clarythromycin, and tinidazole is indeed highly effective for both cure of H. pylori infection and for healing of peptic ulcers, is easy to perform, is cheap, and is without clinically significant side effects, even in a larger population

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