H-2-ANTAGONIST MAINTENANCE THERAPY VERSUS HELICOBACTER-PYLORI ERADICATION IN PATIENTS WITH CHRONIC DUODENAL-ULCER DISEASE - A PROSPECTIVE-STUDY

Background: Few outcome studies directly compare Helicobacter pylori e radication therapy with maintenance H-2-antagonist therapy in duodenal ulcer disease. Aim: TO examine prospectively the efficacy of H. pylor i eradication therapy with ranitidine maintenance therapy over 1 year in patients with confirmed chronic duodenal ulcer, Methods: One hundre d and nineteen patients with active H, pylori infection were randomize d to receive ranitidine, 150 mg/day initially (58 patients), or omepra zole, 40 mg/day, amoxycillin 2 g/day and metronidazole 1.2 g/day for 1 4 days, or omeprazole 40 mg/day and clarithromycin 1.5 g/day, for 14 d ays (if penicillin-allergic). Symptoms were assessed using the Gastroi ntestinal System Rating Scale (GSRS) and SF36 quality of life index. R esults: C-13 urea breath testing confirmed overall treatment success i n 100% of patients (58/58) per protocol and 95.1% (58/61) on an intent ion-to-treat basis. At 4 and 12 months there were no differences in an y GSRS symptoms between treatment groups, SF36 analysis showed a perce ived health improvement at 4 and 12 months in patients who received H. pylori eradication. However, despite successful H, pylori eradication , one-fifth of patients still required antisecretory therapy, Conclusi on: Following successful H. pylori eradication, chronic duodenal ulcer patients were at least as well symptomatically as when taking mainten ance ranitidine. They perceived that their health had improved, but a subgroup was still acid-suppression dependent.