EROSIVE DUODENITIS - PREVALENCE OF HELICOBACTER-PYLORI INFECTION AND RESPONSE TO ERADICATION THERAPY WITH OMEPRAZOLE PLUS 2 ANTIBIOTICS

Objectives: To study the prevalence of Helicobacter pylori infection i n patients with erosive duodenitis (ED), the associated gastric histol ogical lesions and their response to eradication therapy with omeprazo le plus two antibiotics.Methods: A prospective study was made of 57 pa tients with ED (mean age 46 +/- 16 years, 72% males). At endoscopy, bi opsies from gastric antrum and body were obtained for histological stu dy (haematoxylin and eosin). A C-13-urea breath test was also performe d. Omeprazole 20 mg twice daily plus two antibiotics (amoxycillin 1 g twice daily, clarithromycin 500 mg twice daily, metronidazole 500 mg t wice daily) were administered for 1 week. Endoscopy and breath test we re repeated 1 month after completing therapy, and the breath test was performed again at 6 months. Results: All patients were H. pylori posi tive. Overall eradication was achieved in 86% (95% Cl 75-93%). Duodena l erosion healing was obtained in 45 patients (79%). Healing was achie ved in 86% (Cl 73-93%) of cases with successful eradication therapy, b ut only in 3/8 (37%; Cl 8.5-75%) patients with therapy failure (P< 0.0 1). In the multivariate analysis, H. pylori eradication was the only v ariable which correlated with erosion healing (odds ratio 10; Cl 2-51; P< 0.01). Histological improvement, in both the gastric antrum and bo dy, was demonstrated when eradication was achieved (P< 0.001). Six mon ths after diagnosis H. pylori absence was confirmed in all patients wi th initial therapy success (all of them asymptomatic), and infection w as confirmed in the eight patients who were H. pylori positive after t herapy (six of them symptomatic). At 6-month follow-up, endoscopy was normal in 6/7 H. pylori-negative patients with previously persistent E D, while erosions were still present in 4/5 H. pylori-positive patient s with previously persistent ED. Conclusion: A high prevalence (100%) of H. pylori infection in patients with ED was observed. A 1-week twic e daily therapy with omeprazole plus two antibiotics (clarithromycin p lus amoxycillin or metronidazole) was very effective in H. pylori erad ication, duodenal erosion healing, symptomatic improvement, and in dis appearance of associated histological gastritis. These observations su ggest that ED should be considered a variant form of duodenal ulcer di sease and treated accordingly; that is, with H. pylori eradication the rapy.