RECURRENCE OF DUODENAL-ULCERS DURING 5 YEARS OF FOLLOW-UP AFTER CURE OF HELICOBACTER-PYLORI INFECTION

Background: Chronic Helicobacter pylori-associated gastritis is now wi dely accepted as one of the most important pathogenic factors in duode nal ulcer disease. However, little is known about for how long patient s remain free of duodenal ulcer relapses after H. pylori infection has been cured. In the present study, we investigated remission time duri ng a 5-year follow-up period after anti-H. pylori treatment. Methods: The patients were randomly allocated to treatment with either a combin ation of 3x600mg bismuth subsalicylate and 2x1000mg amoxycillin or 3x6 00mg bismuth subsalicylate monotherapy. Endoscopy, including histologi cal and microbiological examination of biopsies, was performed 4 weeks after termination of treatment and after 1 and 2 years. During the th ird, fourth and fifth years of the follow-up period, patients were mon itored twice a year for symptoms compatible with ulcer relapse and for their use of anti-ulcer medication. Endoscopic and histological exami nations were carried out whenever symptoms occurred. Results: Of 56 ev aluated patients, 47 showed healing of ulcers after bismuth subsalicyl ate plus amoxycillin compared with 44 of 57 after bismuth subsalicylat e monotherapy. H. pylori infection was cured in 52% (29 of 56) of the patients after combined therapy and in 4% (2 of 57) after the monother apy. The cumulative duodenal ulcer relapse rates after 5 years were 38 % (18 of 47) after the combined therapy and 75% (33 of 44) after the m onotherapy. In patients who were cured of H. pylori infection, the cum ulative duodenal ulcer relapse rate after 5 years was 9.7% (3 of 31), compared with 81.7% (49 of 60) in those patients who remained H. pylor i-positive after treatment (P < 0.001). In two of the three patients w ho suffered duodenal ulcer relapse after being cured of H. pylori infe ction, H. pylori was present again at the time of relapse. Conclusion: The data suggest that curing H. pylori infection results in long-term cure of duodenal ulcer disease and that duodenal ulcer relapses in su ccessfully treated patients are most often associated with H. pylori r einfection.