Antimicrobial treatment for peptic stenosis: a prospective study

Objective Peptic stenosis, a complication of peptic ulcer disease, is treat ed by endoscopic balloon dilation or surgery. However, recent reports showe d that Helicobacter pylori eradication may resolve peptic stenosis. Thus, w e carried out a prospective study on a cohort of patients with peptic steno sis and H, pylori infection to evaluate the efficacy of anti- H, pylori the rapy in the treatment of peptic stenosis. Design/Methods From May 1995 to May 1998 we studied 22 consecutive patients with benign peptic stenosis (16 with duodenal stenosis and six with pylori c stenosis) and H. pylori infection. Searches for H. pylori were made at fi rst diagnosis of peptic stenosis and at every endoscopic control, All patie nts were treated with an anti- H, pylori treatment (13 with omeprazole/clar ithromycin/metronidazole and nine with omeprazole/amoxycillin/clarithromyci n), followed by 8 weeks' therapy with a proton-pump inhibitor, Endoscopic c ontrols were performed after the end of H. pylori-eradication therapy, at 2 and 6 months, and then every 6 months. Results H, pylori eradication was achieved in all patients, Peptic stenosis disappeared completely in 20/22 cases (17/20 after 2 months and 3/20 after 6 months), and in all these patients the symptoms disappeared within 2 mon ths. At the median follow-up of 12.4 months (range 2-24), the patients rema ined asymptomatic, without recurrence of the stenosis, and needed no medica tion. In one patient the stenosis disappeared partially and symptoms improv ed, and it was successfully treated with cisapride, In one patient the sten osis did not disappear despite H. pylori eradication and continuous proton- pump inhibitor treatment, The patient was treated with a liquid diet due to old age, but he died 4 months after H. pylori eradication due to stroke. Conclusions H, pylori eradication is a safe and effective therapy for pepti c stenosis, Endoscopic balloon dilation or surgery should be used only afte r failure of this conservative treatment, Eur J Gastroenterol Hepatol 11:73 1-734 (C) 1999 Lippincott Williams & Wilkins.