The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Effect of Triple Therapy (Antibiotics plus Bismuth) on Duodenal Ulcer Healing: A Randomized Controlled Trial

David Y. Graham, MD; Ginger M. Lew, PA-C; Dolores G. Evans, PhD; Doyle J. Evans Jr., PhD; and Peter D. Klein, PhD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the Department of Veterans Affairs, by grant DK 39919 from the National Institute of Diabetes and Digestive and Kidney Diseases, by the U. S. Department of Agriculture/Agricultural Research Service Children's Nutrition Center, and by Hilda Schwartz. The ranitidine was supplied by Glaxo and the Pepto-Bismol tablets by Procter and Gamble.

Requests for Reprints: David Y. Graham, MD, Veterans Affairs Medical Center (111D), 2002 Holcombe Boulevard, Houston, TX 77030.

Current Author Addresses: Drs. Graham, Evans, Evans, and Ms. Lew: Veterans Affairs Medical Center (111D) 2002 Holcombe Boulevard, Houston, TX 77030.

Dr. Klein: Children's Nutrition Research Center, 1100 Bates Street, Houston, TX 77030.

Ann Intern Med. 1991;115(4):266-269. doi:10.7326/0003-4819-115-4-266
Text Size: A A A

Objective: To determine whether antimicrobial therapy for Helicobacter pylori infection accelerates the healing of duodenal ulcers.

Design: Single-blind, randomized, controlled trial.

Setting: Veterans Affairs hospital.

Participants: One hundred and five patients with endoscopically verified duodenal ulcers.

Intervention: Patients received either ranitidine, 300 mg/d, or ranitidine, 300 mg/d, plus "triple therapy" (2 g/d of tetracycline, 750 mg/d of metronidazole, and 5 or 8 bismuth subsalicylate tablets per day). Triple therapy was administered for only the first 2 weeks of ulcer treatment.

Measurements: Videoendoscopic assessment of ulcer status was done until ulcer healing was complete. Evaluations were done after 2, 4, 8, 12, and 16 weeks of therapy.

Main Results: Ulcer healing was more rapid in patients receiving ranitidine plus triple therapy than in patients receiving ranitidine alone (P < 0. 01). The cumulative percentages of patients with healed ulcers in the group receiving ranitidine plus triple therapy and in the group receiving ranitidine alone were as follows: 37% and 18% after week 2; 74% and 53% after week 4; 84% and 68% after week 8; 96% and 80% after week 12; and 98% and 84% after week 16.

Conclusion: Combined therapy with anti-H. pylori agents and ranitidine was superior to ranitidine alone for duodenal ulcer healing. Our results indicate that H. pylori plays a role in duodenal ulcer disease.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Helicobacter pylori and gastric or duodenal ulcer. Prescrire Int 2016;25(167):18-23.
Eradication of Helicobacter pylori Infection. Curr Gastroenterol Rep 2016;18(7):33.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.