A three-day course of intravenous omeprazole plus antibiotics for H. pylori-positive bleeding duodenal ulcer

BACKGROUND/AIMS: This prospective trial aimed to test the efficacy of 3-day intravenous omeprazole plus antibiotics for Helicobacter pylori (H. pylori ) eradication rate, and to see whether individualized response to omeprazol e in intragastric pH elevation will alter the success of eradication. METHODOLOGY: One hundred and thirty-eight cases with H. pylori-positive duo denal ulcer bleeding were randomized into four therapy groups: Group 1 (n = 32) received a 3-day course of intravenous omeprazole (80mg loading then 4 0mg q 9am & 9pm) plus ampicillin/salbactum (1.5gm iv loading then 750mg q 9 am, 3pm, & 9pm); Group 2 (n = 35) followed protocol as for Group 1 except t he antibiotics were metronidazole and erythromycin (both 500mg iv q 9am, 3p m, & 9pm). Group 3 (n = 31) followed protocol as for Group 1 and further ad ded with erythromycin (both 500mg iv q 9am, 3pm, & 9pm). Group 4 served as a control group (n = 40) receiveing oral dual therapy after leaving the eme rgency room (omeprazole 20mg and amoxycillin 1g bid x2 weeks). In each case , three gastric biopsies were done for total histologic density of H. pylor i (THPD) (range: 0-15) before, 1 day and 6 weeks after completion of therap y. Except for the control group, the 24-hour ambulatory intragastric pH met er (MIC Inc, Gastrograph Spark III, Swiss) was inserted as possible on the 2nd day of therapy. RESULTS: The 3-day intravenous regimens achieved high clearance rates of H. pylori (Group 1: 93.8%; Group 2: 93.9%; Group 3: 100%). The eradication ra tes of H. pylori in Groups 1-4 were 43.8%, 57.1%, 58.1%, and 72.8%, respect ively. In Groups 1-3, the H. pylori-eradicated cases had lower pre-treatmen t THPD than non-eradicated cases (6.01 vs. 9.24, p<0.001). Among 72 cases w ith pH meter insertion, the percentage of intragastric pH >5.3 during 24-ho ur was not different among 35 H. pylori non-eradicated and 37 eradicated ca ses (78.7 vs. 76.7%, p>0.05). CONCLUSIONS: The 3-day intravenous regimens may achieve clearance of H. pyl ori quickly. However, they were not so effective for eradication, especiall y in cases with higher bacterial loads. The interindividual response to ome prazole in intragastric pH elevation under the study dosage had insignifica nt variations to alter the success of eradication.