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Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention
The effect of Helicobacter pylori in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) is unclear. We investigated the effects of H. pylori eradication in patients with current or previous peptic ulceration, dyspepsia, or both who continued to use NSAIDs. 285 patients were randomly a...
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| Published in: | The Lancet (British edition) 1998-09, Vol.352 (9133), p.1016-1021 |
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| Main Authors: | , , , , , , , , |
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| container_title | The Lancet (British edition) |
| container_volume | 352 |
| creator | Hawkey, C J Tulassay, Z Szczepanski, L van Rensburg, C J Filipowicz-Sosnowska, A Lanas, A Wason, C M Peacock, R A Gillon, K R |
| description | The effect of Helicobacter pylori in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) is unclear. We investigated the effects of H. pylori eradication in patients with current or previous peptic ulceration, dyspepsia, or both who continued to use NSAIDs.
285 patients were randomly assigned omeprazole 20 mg, amoxycillin 1000 mg, and clarithromycin 500 mg, twice daily (n=142, H. pylori eradication treatment), or omeprazole with placebo antibiotics (n=143, controls) for 1 week. All patients received omeprazole 20 mg once daily for 3 weeks until endoscopy, and, if the ulcer was not healed, 40 mg once daily until repeat endoscopy at 8 weeks. Ulcer-free patients with mild dyspepsia continued NSAIDs but not antiulcer treatment. We investigated ulcers with endoscopy at 1, 3, and 6 months and with carbon-13-labelled urea breath test at 3 months.
The estimated probability of being ulcer-free at 6 months was 0.56 (95% CI 0.47-0.65) on eradication treatment and 0.53 (0.44-0.62) on on control treatment (p=0.80). Time to treatment failure did not differ between groups for ulcers or dyspepsia alone, per-protocol analysis, or final H. pylori status. 66% (58-74) of the eradication group compared with 14% (8-20) of the control group had a final negative H. pylori result (p |
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285 patients were randomly assigned omeprazole 20 mg, amoxycillin 1000 mg, and clarithromycin 500 mg, twice daily (n=142, H. pylori eradication treatment), or omeprazole with placebo antibiotics (n=143, controls) for 1 week. All patients received omeprazole 20 mg once daily for 3 weeks until endoscopy, and, if the ulcer was not healed, 40 mg once daily until repeat endoscopy at 8 weeks. Ulcer-free patients with mild dyspepsia continued NSAIDs but not antiulcer treatment. We investigated ulcers with endoscopy at 1, 3, and 6 months and with carbon-13-labelled urea breath test at 3 months.
The estimated probability of being ulcer-free at 6 months was 0.56 (95% CI 0.47-0.65) on eradication treatment and 0.53 (0.44-0.62) on on control treatment (p=0.80). Time to treatment failure did not differ between groups for ulcers or dyspepsia alone, per-protocol analysis, or final H. pylori status. 66% (58-74) of the eradication group compared with 14% (8-20) of the control group had a final negative H. pylori result (p<0.001). Fewer baseline gastric ulcers healed among eradication-treatment patients than among controls (72 vs 100% at 8 weeks, p=0.006).
H. pylori eradication in long-term users of NSAIDs with past or current peptic ulcer or troublesome dyspepsia led to impaired healing of gastric ulcers and did not affect the rate of peptic ulcers or dyspepsia over 6 months.</description><identifier>ISSN: 0140-6736</identifier><identifier>PMID: 9759744</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amoxicillin - therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Clarithromycin - therapeutic use ; Dyspepsia - etiology ; Dyspepsia - microbiology ; Female ; Helicobacter Infections - drug therapy ; Helicobacter pylori ; Humans ; Life Tables ; Male ; Middle Aged ; Omeprazole - therapeutic use ; Peptic Ulcer - complications ; Peptic Ulcer - drug therapy ; Peptic Ulcer - microbiology ; Recurrence ; Risk Factors</subject><ispartof>The Lancet (British edition), 1998-09, Vol.352 (9133), p.1016-1021</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9759744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hawkey, C J</creatorcontrib><creatorcontrib>Tulassay, Z</creatorcontrib><creatorcontrib>Szczepanski, L</creatorcontrib><creatorcontrib>van Rensburg, C J</creatorcontrib><creatorcontrib>Filipowicz-Sosnowska, A</creatorcontrib><creatorcontrib>Lanas, A</creatorcontrib><creatorcontrib>Wason, C M</creatorcontrib><creatorcontrib>Peacock, R A</creatorcontrib><creatorcontrib>Gillon, K R</creatorcontrib><title>Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>The effect of Helicobacter pylori in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) is unclear. We investigated the effects of H. pylori eradication in patients with current or previous peptic ulceration, dyspepsia, or both who continued to use NSAIDs.
285 patients were randomly assigned omeprazole 20 mg, amoxycillin 1000 mg, and clarithromycin 500 mg, twice daily (n=142, H. pylori eradication treatment), or omeprazole with placebo antibiotics (n=143, controls) for 1 week. All patients received omeprazole 20 mg once daily for 3 weeks until endoscopy, and, if the ulcer was not healed, 40 mg once daily until repeat endoscopy at 8 weeks. Ulcer-free patients with mild dyspepsia continued NSAIDs but not antiulcer treatment. We investigated ulcers with endoscopy at 1, 3, and 6 months and with carbon-13-labelled urea breath test at 3 months.
The estimated probability of being ulcer-free at 6 months was 0.56 (95% CI 0.47-0.65) on eradication treatment and 0.53 (0.44-0.62) on on control treatment (p=0.80). Time to treatment failure did not differ between groups for ulcers or dyspepsia alone, per-protocol analysis, or final H. pylori status. 66% (58-74) of the eradication group compared with 14% (8-20) of the control group had a final negative H. pylori result (p<0.001). Fewer baseline gastric ulcers healed among eradication-treatment patients than among controls (72 vs 100% at 8 weeks, p=0.006).
H. pylori eradication in long-term users of NSAIDs with past or current peptic ulcer or troublesome dyspepsia led to impaired healing of gastric ulcers and did not affect the rate of peptic ulcers or dyspepsia over 6 months.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amoxicillin - therapeutic use</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Clarithromycin - therapeutic use</subject><subject>Dyspepsia - etiology</subject><subject>Dyspepsia - microbiology</subject><subject>Female</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter pylori</subject><subject>Humans</subject><subject>Life Tables</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Omeprazole - therapeutic use</subject><subject>Peptic Ulcer - complications</subject><subject>Peptic Ulcer - drug therapy</subject><subject>Peptic Ulcer - microbiology</subject><subject>Recurrence</subject><subject>Risk Factors</subject><issn>0140-6736</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><recordid>eNpVkMFOwzAQRHMAlVL4BCSfuAU5ceIQblUppFIEFfQeOfYaGTl2sB2k_BjfhxE9wGnfamZ3pDlJljgrcEorQs-Sc-_fMcYFxeUiWdRVWVdFsUy-XpgRdlAeBOLWBGe1jhicYhpZiRrQitue8QAOjbO2TiFwTCjOgrIGKYPGSGCCR3E11qQ-Wq0S8Z6ZoFJlpGbDwIJ1MxJuevN3qNm2e_T0ut7de-TDJOab_0HbPwnSOtSC_8G9g8-YFPEiOZVMe7g8zlVyeNgeNk3aPj_uNus2HUtSpDVjEkrJxG0FXGZ9KUiW16IXPRGE0B73OaE5JRgwzTmUlENecMlwFkVOgayS69-3o7MfE_jQxaY4aM0M2Ml3FamLmmQkGq-OxqkfQHSjUwNzc3fsmXwDGcJ94Q</recordid><startdate>19980926</startdate><enddate>19980926</enddate><creator>Hawkey, C J</creator><creator>Tulassay, Z</creator><creator>Szczepanski, L</creator><creator>van Rensburg, C J</creator><creator>Filipowicz-Sosnowska, A</creator><creator>Lanas, A</creator><creator>Wason, C M</creator><creator>Peacock, R A</creator><creator>Gillon, K R</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19980926</creationdate><title>Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention</title><author>Hawkey, C J ; Tulassay, Z ; Szczepanski, L ; van Rensburg, C J ; Filipowicz-Sosnowska, A ; Lanas, A ; Wason, C M ; Peacock, R A ; Gillon, K R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p534-9aafe5fad87ecf1b5d3129dbdb3d336b0b2362630e062ce56ce24cfa0136bc6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amoxicillin - therapeutic use</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</topic><topic>Clarithromycin - therapeutic use</topic><topic>Dyspepsia - etiology</topic><topic>Dyspepsia - microbiology</topic><topic>Female</topic><topic>Helicobacter Infections - drug therapy</topic><topic>Helicobacter pylori</topic><topic>Humans</topic><topic>Life Tables</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Omeprazole - therapeutic use</topic><topic>Peptic Ulcer - complications</topic><topic>Peptic Ulcer - drug therapy</topic><topic>Peptic Ulcer - microbiology</topic><topic>Recurrence</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hawkey, C J</creatorcontrib><creatorcontrib>Tulassay, Z</creatorcontrib><creatorcontrib>Szczepanski, L</creatorcontrib><creatorcontrib>van Rensburg, C J</creatorcontrib><creatorcontrib>Filipowicz-Sosnowska, A</creatorcontrib><creatorcontrib>Lanas, A</creatorcontrib><creatorcontrib>Wason, C M</creatorcontrib><creatorcontrib>Peacock, R A</creatorcontrib><creatorcontrib>Gillon, K R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hawkey, C J</au><au>Tulassay, Z</au><au>Szczepanski, L</au><au>van Rensburg, C J</au><au>Filipowicz-Sosnowska, A</au><au>Lanas, A</au><au>Wason, C M</au><au>Peacock, R A</au><au>Gillon, K R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1998-09-26</date><risdate>1998</risdate><volume>352</volume><issue>9133</issue><spage>1016</spage><epage>1021</epage><pages>1016-1021</pages><issn>0140-6736</issn><abstract>The effect of Helicobacter pylori in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) is unclear. We investigated the effects of H. pylori eradication in patients with current or previous peptic ulceration, dyspepsia, or both who continued to use NSAIDs.
285 patients were randomly assigned omeprazole 20 mg, amoxycillin 1000 mg, and clarithromycin 500 mg, twice daily (n=142, H. pylori eradication treatment), or omeprazole with placebo antibiotics (n=143, controls) for 1 week. All patients received omeprazole 20 mg once daily for 3 weeks until endoscopy, and, if the ulcer was not healed, 40 mg once daily until repeat endoscopy at 8 weeks. Ulcer-free patients with mild dyspepsia continued NSAIDs but not antiulcer treatment. We investigated ulcers with endoscopy at 1, 3, and 6 months and with carbon-13-labelled urea breath test at 3 months.
The estimated probability of being ulcer-free at 6 months was 0.56 (95% CI 0.47-0.65) on eradication treatment and 0.53 (0.44-0.62) on on control treatment (p=0.80). Time to treatment failure did not differ between groups for ulcers or dyspepsia alone, per-protocol analysis, or final H. pylori status. 66% (58-74) of the eradication group compared with 14% (8-20) of the control group had a final negative H. pylori result (p<0.001). Fewer baseline gastric ulcers healed among eradication-treatment patients than among controls (72 vs 100% at 8 weeks, p=0.006).
H. pylori eradication in long-term users of NSAIDs with past or current peptic ulcer or troublesome dyspepsia led to impaired healing of gastric ulcers and did not affect the rate of peptic ulcers or dyspepsia over 6 months.</abstract><cop>England</cop><pmid>9759744</pmid><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 1998-09, Vol.352 (9133), p.1016-1021 |
| issn | 0140-6736 |
| language | eng |
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| source | Elsevier; BSC - Ebsco (Business Source Ultimate) |
| subjects | Adolescent Adult Aged Aged, 80 and over Amoxicillin - therapeutic use Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Clarithromycin - therapeutic use Dyspepsia - etiology Dyspepsia - microbiology Female Helicobacter Infections - drug therapy Helicobacter pylori Humans Life Tables Male Middle Aged Omeprazole - therapeutic use Peptic Ulcer - complications Peptic Ulcer - drug therapy Peptic Ulcer - microbiology Recurrence Risk Factors |
| title | Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention |
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