David Y. Graham, MD; Ginger M. Lew, PA-C; Peter D. Klein, PhD; Dolores G. Evans, PhD; Doyle J. Evans, PhD; Zahid A. Saeed, MD; Hoda M. Malaty, MD
▪ Objective: To determine the effect of treating Helicobacter pylori infection on the recurrence of gastric and duodenal ulcer disease.
▪ Design: Follow-up of up to 2 years in patients with healed ulcers who had participated in randomized, controlled trials.
▪ Setting: A Veterans Affairs hospital.
▪ Participants: A total of 109 patients infected with H. pylori who had a recently healed duodenal (83 patients) or gastric ulcer (26 patients) as confirmed by endoscopy.
▪ Intervention: Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet) and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given.
▪ Measurements: Endoscopy to assess ulcer recurrence was done at 3-month intervals or when a patient developed symptoms, for a maximum of 2 years.
▪ Results: The probability of recurrence for patients who received triple therapy plus ranitidine was significantly lower than that for patients who received ranitidine alone: for patients with duodenal ulcer, 12% (95% Cl, 1% to 24%) compared with 95% (Cl, 84% to 100%); for patients with gastric ulcer, 13% (Cl, 4% to 31%) compared with 74% (44% to 100%). Fifty percent of patients who received ranitidine alone for healing of duodenal or gastric ulcer had a relapse within 12 weeks of healing. Ulcer recurrence in the triple therapy group was related to the failure to eradicate H. pylori and to the use of nonsteroidal anti-inflammatory drugs.
▪ Conclusions: Eradication of H. pylori infection markedly changes the natural history of peptic ulcer in patients with duodenal or gastric ulcer. Most peptic ulcers associated with H. pylori infection are curable.
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Graham DY, Lew GM, Klein PD, Evans DG, Evans DJ, Saeed ZA, et al. Effect of Treatment of Helicobacter pylori Infection on the Long-term Recurrence of Gastric or Duodenal Ulcer: A Randomized, Controlled Study. Ann Intern Med. 1992;116:705-708. doi: 10.7326/0003-4819-116-9-705
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Published: Ann Intern Med. 1992;116(9):705-708.
Gastroenterology/Hepatology, H. Pylori, Infectious Disease, Peptic Disease, Peptic Ulcer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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