THE IMPACT OF HELICOBACTER-PYLORI ERADICATION ON PEPTIC-ULCER HEALING

Objective: Current literature was reviewed analyzing the outcome of pe ptic ulcer healing in relation to the results of the posttherapeutic H elicobacter pylori (HP) status. Methods: Literature was reviewed along with an analysis of 60 studies, comprising a total of 4329 patients. Results: Successful Helicobacter pylori eradication was found to induc e a better response in peptic ulcer healing, regardless of diagnosis: gastric ulcer 88% vs 73% (odds ratio COR] 2.7, p < 0.01), duodenal ulc er 95% vs 76% (OR 5.6,p < 0.0001), and peptic ulcer 95% vs 76% (OR 6.6 , p < 0.0001), for patients having their HP infection successfully cur ed versus those remaining HP-positive, respectively (Fisher's exact te st). For all evaluated time points (less than or equal to 6, 7-8, and 10-12 wk after beginning treatment), HP-negative patients had higher h ealing rates than HP-positive patients (95% vs 82%, 94% vs 69%, and 96 % vs 78% with corresponding OR of 4.2, 6.5, and 7.4, all p < 0.0001, F isher's exact test). The use of concomitant acid suppression therapy d uring initial HP eradication provided a benefit on peptic ulcer healin g only for patients with persistent HP infection (improved healing rat es of 78% vs 67%; otherwise rates were 94-96%). Likewise, prolonged ac id inhibition in HP treatment failures after the initial HP treatment phase resulted in 7-20% improved healing rates, whereas patients becom ing HP-negative did not profit. Conclusion: Successful HP eradication therapy accelerates peptic ulcer healing even without concomitant acid suppression. (C) 1998 by Am. Cell. of Gastroenterology.