Central Role of Helicobacter pylori in Gastric Ulcers


Central Role of Helicobacter pylori in Gastric Ulcers

Reference: Labenz J & Bîrsch G: Evidence for the essential role of Helicobacter pylori in gastric ulcer disease. Gut 35: 19-22, 1994.

Summary: This paper describes an uncontrolled, nonrandomized study of eighty-three patients with culture or histologically confirmed Helicobacter pylori infection and gastric ulcer. Five patients were lost to followup, all the other subjects received various combinations of antibiotics and/or acid suppressing drugs for six weeks. These combinations included omeprazole and ciprofloxacin (for one or two weeks); omeprazole and amoxicillin (in four different dose and timing combinations); and omeprazole and roxithromycin for two weeks. After this, all patients had ranitidine or omeprazole for four or five weeks.

All results were confirmed by endoscopy. Out of seventy-eight patients, fifty-three had no evidence of H. pylori infection after four weeks. Amoxicillin plus omeprazole had the greatest efficacy (though not significantly so) in eradication, whereas ciproflaxcin with omeprazole was ineffective. Complete healing of gastric ulcers was seen in 77% of patients, most of whom came from the group in which H. pylori had been eradicated.

A subset of fifty subjects was followed for one year in addition. One of thirty-two patients who had their H. pylori eradicated had ulcer relapse compared to ten of eighteen patients with persistent H. pylori infection. The authors conclude that this study provides evidence that most gastric ulcers previously considered idiopathic may actually be due to infection by H. pylori, and that eradication of the infection will heal and prevent future gastric ulcers.

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