Helicobacter pylori and bleeding duodenal ulcer: prevalence of the infection, efficacy of three triple therapies and role of eradication in the prevention of recurrent hemorrhage

BACKGROUND: To report the prevalence of Helicobacter pylori in patients wit h bleeding duodenal ulcer and to verify the effect of eradication on hemorr hage recurrence. To evaluate the efficacy on H. pylori eradication and on u lcer healing of three one-week triple therapies and to compare their effica cy with that of a dual therapy. PATIENTS AND METHODS: One-hundred and eleven patients with bleeding duodena l ulcer not taking gastroerosive drugs were prospectively studied. At endos copy, biopsies from gastric antrum and body were obtained (haematoxylin-eos in), and a C-13-urea breath test was also performed. Both diagnostic method s were repeated one month after completing one of the following treatments (randomized study): omeprazole (20 mg/12 h), amoxycillin (1 g/12 h) and cla rithromycin (500 mg/12 h) (OAC, n = 27); omeprazole (20 mg/12 h), clarithro mycin (500 mg/12 h) and metronidazole (500 mg/12 h) (OCM, n = 27); lansopra zole (30 mg/12 h), amoxycillin (1 g/12 h) and clarithromycin (500 mg/12 h) (LAC, n = 27), and lansoprazole (30 mg/12 h) and clarithromycin (500 mg/8 h ) (LC, n = 27). The first three therapies were administered for one week, a nd LC for two weeks. Once eradication was confirmed no antisecretory therap y was administered. A breath test was performed in the follow-up at 6 month s and at one year. RESULTS: The prevalence of H. pylori infection was 97.3% (95% CI: 92-99%). Five patients were last from study during follow-up. The eradication effica cy (intention-to-treat) was: OAC, 89% (72-96%); OCM: 93% (77-98%); LAG, 93% (77-98%), and LC, 70% (51-84%). Overall triple therapy efficacy was higher than that of dual therapy (91% vs 70%; p < 0.05). Thirteen patients needed a 2(nd) or 3(rd) therapy, and eradication success was finally achieved in all cases. The type of therapy was the only variable which influenced on H. pylori eradication (OR: 4.5; 95% CI: 1.4-14%; p < 0.01) and H. pylori erad ication was the only variable which influenced on ulcer healing (OR: 4.7; 9 5% CI: 1.2-19%; p < 0.05). The yearly reinfection rate was 2.8% (0.9-7.8%), No hemorrhage recurrences occurred during the one year follow-up period. CONCLUSIONS: H. pylori prevalence in bleeding duodenal ulcer is almost 100% . These patients will be spared of hemorrhage recurrence at least for one y ear if infection is eradicated. Therefore, eradication therapy is the thera py of choice, and maintenance therapy with antisecretory drugs is no longer needed. One-week triple therapies with a proton pump inhibitor and two ant ibiotics (clarithromycin plus amoxycillin or metronidazole) have a high eff icacy in patients with bleeding duodenal ulcer.