Helicobacter Pylori Eradication as the Sole Treatment for Gastric and Duodenal Ulcers

Eur J Gastroenterol Hepatol. 2005 Jan;17(1):93-101. doi: 10.1097/00042737-200501000-00018.

Abstract

Objectives: It is uncertain whether eradication of Helicobacter pylori--without a prolonged suppression of acid secretion--is sufficient to allow healing of peptic ulcers. We evaluated whether eradication of H. pylori with no following anti-secretory medication then administered is sufficient for treatment of peptic ulcers. We also looked at the impact of non-steroidal anti-inflammatory drug (NSAID) and acetylsalicylic acid (ASA) use on ulcer relapses.

Methods: The effect of eradication on ulcer healing and relapse rate was analysed in 115 patients, randomly allocated to four treatment groups: (1) quadruple therapy (28); (2) dual therapy (n-30); (3) triple therapy (n=27); and (4) lansoprazole and placebo (n=30). Endoscopic assessment was performed at 0, 8, and 52 weeks.

Results: The ulcer healing rate was 100% [95% confidence interval (CI), 95-100%] in H. pylori-negative and 83% (95% CI, 67-94%) in H. pylori-positive patients (P<0.01). In patients who used NSAIDS or ASA, the healing rates was 100% (95% CI, 73-100%) and 75% (95% CI, 19-99%) in H. pylori-negative (12 patients) and H. pylori-positive patients (four patients) (P = not significant). Ulcer relapses occurred in 5% (95% CI, 1-13%) of H. pylori-negative and in 36% (95% CI, 19-56%) of H. pylori-positive patients (P < 0.01). In H. pylori-negative patients who used NSAIDs or ASA the ulcer relapse rate was 30% (95% CI, 7-65%), whereas the ulcer relapse rate was 2% (95% CI, 0.4-10%) in patients who did not use NSAIDs or ASA (P < 0.05). No difference in ulcer relapse rate in H. pylori-positive patients who used or did not use NSAIDs or ASA was found. The eradication rate of H. pylori was 93% (95% CI, 76-99%) in the quadruple therapy group, 83% (95% CI, 64-94%) in the dual therapy group, 100% (95% CI, 87-100%) in the triple therapy group, and 0% (95% CI, 0-12%) in the lansoprazole and placebo group.

Conclusions: Eradication treatment for H. pylori-positive gastric or duodenal ulcer is sufficient, with no need to follow it with anti-secretory medication. Cure of the infection reduces ulcer relapses in patients who did not use NSAIDs or ASA.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Adult
  • Aged
  • Anti-Bacterial Agents*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anti-Ulcer Agents / therapeutic use
  • Aspirin / therapeutic use
  • Drug Therapy, Combination / therapeutic use*
  • Duodenal Ulcer / drug therapy
  • Duodenal Ulcer / microbiology*
  • Duodenal Ulcer / pathology
  • Female
  • Gastritis / drug therapy
  • Gastritis / microbiology
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Lansoprazole
  • Male
  • Middle Aged
  • Omeprazole / analogs & derivatives*
  • Omeprazole / therapeutic use
  • Prospective Studies
  • Proton Pump Inhibitors
  • Recurrence
  • Stomach Ulcer / drug therapy
  • Stomach Ulcer / microbiology*
  • Stomach Ulcer / pathology
  • Treatment Outcome

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Proton Pump Inhibitors
  • Lansoprazole
  • Omeprazole
  • Aspirin