HELICOBACTER-PYLORI ERADICATION IN A CLINICAL SETTING - SUCCESS RATESAND THE EFFECT ON THE QUALITY-OF-LIFE IN PEPTIC-ULCER

Background: Helicobacter pylori eradication for peptic ulcer has been widely taken up. Evidence for the efficacy of different regimens is of ten derived from small series in clinical trials but there is little r eporting of everyday practice with unselected patients. Freedom from u lcer relapse has been demonstrated, but not whether this equates with clinical success. Methods: We report on a series of 706 patients with H. pylori infection who, between January 1991 and April 1995, received eradication therapy followed by assessment of H. pylori status. Two-h undred and seven of these patients were followed-up by postal question naire, validated by parallel questionnaires to their general practitio ners, covering clinical outcome measures. Results: The overall eradica tion rate was 81.7%, and a 1-week course of omeprazole plus two antibi otics was significantly better than a 2-week course of standard triple therapy (85.0% vs. 78.0%, P < 0.05). Amongst 21 first-time failures, a 7-day course of a clarithromycin-containing triple therapy succeeded in 18. The questionnaire replies indicate that, following successful H. pylori eradication, ulcer patients are less likely to consult with ulcer symptoms (P < 0.0005), take medication (P < 0.0005), require fur ther prescription (P < 0.0005), or lose work-time because of their ulc er (P < 0.005). They are more likely to have a subjective sense of ulc er cure (P < 0.0005). Conclusions: In addition to clear cost savings, social benefits are now demonstrated when H. pylori is eradicated. A w ell-tolerated 1 week regimen is genuinely effective in everyday practi ce.