EFFECT OF ACID SUPPRESSION ON EFFICACY OF TREATMENT FOR HELICOBACTER-PYLORI INFECTION

Eradication of Helicobacter pylori from the stomach by triple therapy with bismuth, tetracycline, and metronidazole cures peptic ulcer disea se. We investigated whether concomitant acid inhibition with omeprazol e would improve the results of triple therapy. 108 consecutive patient s with peptic-ulcer disease and biopsy-proven H pylori infection were randomised to 7 days of triple therapy with or without omeprazole 20 m g twice daily. Patients in the omeprazole-treated group were pretreate d with 3 days of omeprazole. Eradication of H pylori was assessed by 1 0 endoscopic biopsies for urease test, histology, and culture 4-6 week s treatment. 53 of 54 (98.1%) patients treated omeprazole were cured c ompared with 45 of 54 (83.3%) of those not treated (p=0.02), a differe nce in efficacy of 14.8% (95% CI 4.2-25.4%). Most side effects were mi ld and did not interfere with compliance; 105 patients (97.2%) finishe d treatment. Gastro-intestinal side effects were significantly fewer i n the omeprazole group. We conclude that the addition of omeprazole to triple therapy improves efficacy, lessens side effects, and is suffic iently efficacious to obviate the need for a diagnostic test of cure i n compliant patients.