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Eradicate H. pylori infection to eradicate resistant duodenal ulcer

' ... This study demonstrates that long-term eradication of Helicobacter pylori is possible and is synonymous with non-recurrence of duodenal ulcer in patients followed for up to four years.'

82 patients with duodenal ulcer resistant to or recurring after 4 weeks of H2 antagonist administration received ranitidine 150mg bid for 4 weeks and then bismuth salicylate 108mg qid + tetracycline 500mg qid for 4 weeks + metronidazole 200mg qid for 10 days. All patients were infected with H. pylori before triple therapy. while 75 of 78 patients returning for endoscopy 4 weeks after completion of therapy were H. pylori-negative and all 78 had healed uicers. 7 i in . 57/57. 33/ 34 and 15/ l5 patients evaluated at I, 2. 3 and 4 years after therapy completion. respectively. were H. pylori- and duodenal ulcer-free. Of 3 patients who had recurrences of II. pylori infection during foIlow-up. 2 had duodenitis and I was asymptomatic except when extremely hungry.

Several of the patients included in the study had long histories of intractable abdominal pain; the triple anti-infective therapy a dministered produced resolution of pain in thcse patients. Further. duodenal ulcer scarring resolved over time after treatment and adverse effects of therapy, while frequent . were mild . 31 patients entered into the study were smokers and continued to smoke throughout therapy and follow-up, without relapse of ulceration.

'It would seem that to the adage "no acid, no ulcer" we now can certainly add "no Helicobacter pylori, no duodenal ulcer".' George LL. Borody TJ . Andrews P. Dev ine M. Moore-Jones D. et al. Cure o f duodenal ulcer alicr erad ication of I/c/im/>ac{l'r priori. Medica l Journal of Australia 153: 145-149. 6 .... ug 1990

15 Sep 1990 INPllARMACO) ISSN U/56-Z7UJ/YU/UY15-UUU8/ ()$01.OO/ 0 I[) Adis International Ltd