Unhealed Duodenal Ulcers despite Helicobacter pylori Eradication

• Published in: Scandinavian journal of gastroenterology 1997, Vol.32 (7), p.643-650
• Main Authors: Gisbert, J. P., Bojxeda, D., Argila, C. Martíe, Baleriola, I. ÁRez, Abrajra, V., Garcílaza, A.
• Format: Article
• Language: English
• Subjects: Amoxicillin - administration & dosage; Amoxycillin; Anti-Bacterial Agents - administration & dosage; Anti-Ulcer Agents - administration & dosage; Biological and medical sciences; bismuth; Case-Control Studies; clarithromycin; Clarithromycin - administration & dosage; Drug Administration Schedule; Drug Therapy, Combination; duodenal ulcer; Duodenal Ulcer - drug therapy; Duodenal Ulcer - epidemiology; Duodenal Ulcer - microbiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Logistic Models; Male; Medical sciences; metronidazole; Metronidazole - administration & dosage; Middle Aged; omeprazole; Omeprazole - administration & dosage; Organometallic Compounds - administration & dosage; Other diseases. Semiology; Prospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tetracyclines - administration & dosage; therapy; Time Factors; Treatment Outcome; ulcer healing; Wound Healing
• ISSN: 0036-5521; 1502-7708
• DOI: 10.3109/00365529708996512

Background: Our aims were 1) to study the influence of several factors (age, sex, smoking, previous ulcer disease, ulcer size, chronic gastritis, serum gastrin and pepsinogen I levels, therapy regimen and, especially, eradication of Helicobacter pylori) on duodenal ulcer healing; 2) to evaluate the frequency of duodenal ulcer healing failure despite eradication of H. pylori, to study why this failure occurs, and to verify its evolution without antisecretory therapy; and 3) to confirm whether a week's prescription of omeprazole is sufficient to obtain ulcer healing. Methods: Three-hundred and eight patients (mean age, 45 ± 13 years; 71% males) with duodenal ulcer and H. pylori infection were studied prospectively. Biopsy specimens were obtained at initial endoscopy, and serum gastrin and pepsinogen I levels were measured. A repeat endoscopy (with biopsies) was performed 1 month after eradication therapy had been completed, and a 3C-urea breath test was also carried out. Three eradication therapies were used: omeprazole plus amoxycillin for 2 weeks (OA group, n = 61); 'classic' triple therapy (with bismuth; CTT group, n = 65); and 'new' triple therapies for 1 week (NTT group, n = 182): omeprazole plus two of the following antibiotics: clarithromycin, metronidazole, and amoxycillin. When the ulcer did not heal despite successful H. pylori eradication, antacids were prescribed on an as-needed basis, and endoscopy was repeated 1 month later (2nd control endoscopy). If the ulcer was still present, the acid output (basal and pentagastrin-stimulated) was measured, a secretin test was performed, and a final endoscopy (3rd control endoscopy) was carried out after an additional month. The statistical method used was multiple logistic regression. Results: Overall eradication was achieved in 69% (n = 212) of the patients, and ulcer healing in 76% (n = 233): 57% in the OA group, 80% in the CTT group, and 81% in the NTT group (P < 0.01 when comparing the OA group with the others). Ulcer healing was achieved in 90% of H. py/o/v'-eradicated patients and in only 45% of patients with eradication therapy failure (P < 0.001). Similar results were obtained when only patients treated with NTT were considered: ulcer healing in 90% of patients with the organism eradicated. Eradication of H. pylori (odds ratio (OR), 11.8; 95% confidence interval (Cl), 6.3-22) and sex (OR, 2.5; 95% Cl, 1.2-5.1) were the only variables that correlated with ulcer healing in the multivariate analysis.