0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

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 and Author 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
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
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).

Comments

Submit a Comment
Submit a Comment

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.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)