ONE-WEEK ANTIBIOTICS VERSUS MAINTENANCE ACID SUPPRESSION THERAPY FOR HELICOBACTER-PYLORI-ASSOCIATED PEPTIC-ULCER BLEEDING

Bleeding peptic ulcer is the most important cause of upper gastrointes tinal bleeding. Our aim was to compare the effect of anti-Helicobacter -therapy with maintenance treatment of H-2-receptor antagonist in the prevention of relapses of ulcer and bleeding. Patients with bleeding d uodenal or gastric ulcers and H. pylori infection were randomized to r eceive either a one-week course of triple therapy with bismuth subcitr ate, metronidazole, and tetracycline plus ranitidine or a six-week cou rse of ranitidine 300 mg/day. After the ulcers healed, the antibiotic- treated patients were not given any medication, whereas the ranitidine -treated patients continued to receive a maintenance dose of 150 mg/da y. One hundred twenty-six patients were randomized to receive anti-Hel icobacter therapy and 124 patients to receive long-term ranitidine. H. pylori eradication was achieved in 98.2% in those who received triple therapy and 6.1% in those who received ranitidine (P < 0.0001). At th e six-week follow-up, ulcer healing was documented in 85.2% in those w ho received triple therapy and 86.1% in those who received ranitidine (P = 0.639), Recurrent ulcer developed in nine of the ranitidine-treat ed patients and three of them presented with recurrent upper gastroint estinal bleeding. One patient in the antibiotic group developed recurr ent ulcer without rebleeding (P = 0.01). It is concluded that eradicat ion of H. pylori is sufficient for the prevention of recurrent bleedin g ulcers.