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Effect of Treatment of Helicobacter pylori Infection on the Long-term Recurrence of Gastric or Duodenal Ulcer: A Randomized, Controlled Study

David Y. Graham, MD; Ginger M. Lew, PA-C; Peter D. Klein, PhD; Dolores G. Evans, PhD; Doyle J. Evans Jr., PhD; Zahid A. Saeed, MD; and Hoda M. Malaty, MD
[+] 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 Research Center, and by Hilda Schwartz.

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, Jr., Saeed, Malaty, 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. 1992;116(9):705-708. doi:10.7326/0003-4819-116-9-705
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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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