TREATMENT STRATEGIES FOR SYMPTOM RESOLUTION, HEALING, AND HELICOBACTER-PYLORI ERADICATION IN DUODENAL-ULCER PATIENTS

The introduction of anti-Helicobacter pylori therapy has increased the number of options available for the management of patients with duode nal ulcer disease. The aim of this paper is to summarize current knowl edge and use it to form a strategy relevant to the management of patie nts with duodenal ulcer disease. Four key aspects are addressed. (i) S election of duodenal ulcer patients for anti-H. pylori treatment. As t he subgroup of patients who will develop minor disease activity in the future cannot be identified with sufficient precision, and the therap eutic gain achieved by curing H. pylori infection is significant, all patients with duodenal ulcer and H. pylori infection should receive er adication therapy. (ii) Confirmation of H. pylori infection before era dication. A diagnostic test to confirm H. pylori infection is useful i n identifying the small group of H. pylori-negative duodenal ulcer pat ients with non-steroidal anti-inflammatory drug (NSAID)-induced ulcer or Zollinger-Ellison syndrome. (iii) Choice of treatment. This should be based on efficacy of eradication, rate of ulcer healing and symptom resolution, adverse effects profile, simplicity and cost. At present, there are four effective eradication therapies documented: omeprazole plus amoxycillin or clarithromycin; omeprazole, amoxycillin and metro nidazole; 'classic' triple therapy (bismuth, amoxycillin (or tetracycl ine) and metronidazole); and ranitidine, amoxycillin and metronidazole . (iv) Confirmation of eradication after treatment. This is needed cas es in which the chosen therapy has an efficacy below 80-90%. The test is important to identify those patients who require repeated treatment , before they with an ulcer relapse.