Background Persistent infection with Helicobacter pylori isassociated with the recurrence of duodenal ulcer. Whether theefficacy of bismuth therapy in reducing the rate of recurrenceof duodenal ulcer is due to its antimicrobial effects on H.pylori or to a direct protective action on the mucosa is stilla matter of debate.
Methods To study the effect of the eradication of H. pylorion the recurrence of duodenal ulcer, we treated 104 patientswith H. pylori infection and recurrent duodenal ulcer with eitheramoxicillin (750 mg three times daily) plus metronidazole (500mg three times daily) or identical-appearing placebos, givenorally for 12 days. All patients also received ranitidine (300mg each night) for 6 or 10 weeks. Endoscopy was performed beforetreatment and periodically during follow-up for up to 12 monthsafter healing.
Results Among the 52 patients given antibiotics, H. pylori waseradicated in 46, as compared with 1 of the 52 given placebo(89 percent vs. 2 percent, P<0.001). After six weeks, theulcers were healed in 48 patients given antibiotics and 39 givenplacebo (92 percent vs. 75 percent, P = 0.011). Side effects,mainly diarrhea, occurred in 15 percent of the patients givenantibiotics. Among the patients followed up for 12 months, duodenalulcers recurred in 4 of 50 patients given antibiotics and 42of 49 given placebo (8 percent vs. 86 percent, P<0.001).Ulcers recurred in 1 of 46 patients in whom H. pylori had beeneradicated, as compared with 45 of 53 in whom H. pylori persisted(2 percent vs. 85 percent, P<0.001).
Conclusions In patients with recurrent duodenal ulcer, eradicationof H. pylori by a regimen that does not have any direct actionon the mucosa is followed by a marked reduction in the rateof recurrence, suggesting a causal role for H. pylori in recurrentduodenal ulcer.
Source Information
From the Medical Department I and the Department of Pathology, Hanusch Hospital, Vienna (E.H., H.N., K.S.); the Medical Department II, General Hospital, Graz (G.B., H.W.); the Outpatient Department South, Regional Public Medical Insurance, Vienna (B.D.); the Department of Clinical Microbiology, Hygiene Institute, University of Vienna School of Medicine, Vienna (A.M.H.); and the Department of Pathology, University of Graz School of Medicine, Graz (M.T.) -- all in Austria.
Address reprint requests to Dr. Hentschel at Hanusch Hospital, Medical Department I, Heinrich-Collinstr. 30, A-1140 Vienna, Austria.
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