Document Detail


Helicobacter pylori eradication as the sole treatment for gastric and duodenal ulcers.
MedLine Citation:
PMID:  15647648     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Perttu Et Arkkila; Kari Seppälä; Timo U Kosunen; Pentti Sipponen; Judit Mäkinen; Hilpi Rautelin; Martti Färkkilä
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  17     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-13     Completed Date:  2005-04-12     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  93-101     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Finland. perttu.arkkila@hus.fi
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MeSH Terms
Descriptor/Qualifier:
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,  microbiology*,  pathology
Female
Gastritis / drug therapy,  microbiology
Helicobacter Infections / complications,  diagnosis,  drug therapy*
Helicobacter pylori*
Humans
Male
Middle Aged
Omeprazole / analogs & derivatives*,  therapeutic use
Prospective Studies
Proton Pumps / antagonists & inhibitors
Recurrence
Stomach Ulcer / drug therapy,  microbiology*,  pathology
Treatment Outcome
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Anti-Ulcer Agents; 0/Proton Pumps; 103577-45-3/lansoprazole; 50-78-2/Aspirin; 73590-58-6/Omeprazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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