IMPACT OF COLLOIDAL BISMUTH SUBCITRATE IN THE ERADICATION RATES OF HELICOBACTER-PYLORI INFECTION-ASSOCIATED DUODENAL-ULCER USING A SHORT TREATMENT REGIMEN WITH OMEPRAZOLE AND CLARITHROMYCIN - A RANDOMIZED STUDY

Recent trials have shown that duodenal ulcers treated by H2-blockers h eal faster if Helicobacter pylori is eradicated concurrently. Objectiv es: To evaluate the efficacy of a short treatment regimen in H. pylori eradication and ulcer healing and to assess the impact of colloidal b ismuth subnitrate (CBS) in H. pylori eradication rate. Methods: Sixty- one patients with H. pylori-associated duodenal ulcer were randomized in two short treatment groups, Group A patients (31) were given omepra zole 20 mg b.i.d. x 8 days. Clarithromycin (500 mg, b.i.d.) and CBS (1 20 mg, q.i.d.) were added 24 h after starting omeprazole and were give n for 7 days. Group B patients (30) were treated as group A patients b ut without CBS. Endoscopies were performed at entry and 3 wk after the end of treatment. Presence of H. pylori was assessed at each endoscop y by urease test, and biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H. pylori infe ction. No patient received follow-up treatment, Results: H. pylori era dication rates were achieved in 25/31 (80.6%) group A patients and in 15/30 (50 %) in group B patients (p = 0.012). Duodenal ulcer healing w as documented in 30/31 (96.8 %) patients in group A and in 25/30 (83 % ) patients in group B. Conclusions: The addition of CBS to the double therapy with omeprazole and clarithromycin substantially improves the eradication rate of H. pylori. Short therapy with omeprazole 20 mg/b.i .d., clarithromycin 500 mg/b.i.d., and CBS 120 mg/q.i.d. is a safe, we ll tolerated combination that achieves a 80.6% eradication rate of H. pylori and duodenal ulcer healing rates as good as those achieved by o meprazole 20 mg/d when given for 4 wk.