Does the eradication of Helicobacter pylori cure duodenal ulcer disease incommunities with a high prevalence rate? Comparison with long-term acid suppression

The long-term effect of Helicobacter pylori eradication on the natural hist ory of duodenal ulcer has been investigated and compared with long-term aci d suppression treatment in an endemic community for infection. Seventy-thre e patients with endoscopically verified H. pylori positive active duodenal ulcer disease were included in this prospective study. Patients were divide d into two groups. Group A patients (n=39) were given an omeprazole-based t riple eradication regimen, while group B patients (n=34) were given omepraz ole alone followed by long-term famotidine 20 mg daily as maintenance treat ment, A control endoscopy was performed at the third month of treatment. Th e bacterium was eradicated in 32 (82%) of group A patients. All patients we re followed up for two years and an endoscopy performed at the end of each year. H. pylori recurred in 13 patients and the reinfection rate was 44.8% over two years. Duodenal ulcer recurred in seven of these patients at two y ears (24.1%). There was a close association between H. pylori reinfection a nd ulcer relapse. Group B patients remained H. pylori positive during the s tudy and the ulcer recurred in five of these patients (16.6%) despite conti nuous famotidine treatment, There was no statistically significant differen ce in ulcer relapse rate between the groups. These results suggested that H . pylori eradication is not an absolute solution for duodenal ulcer disease in high endemic regions and continuous maintenance treatment with H2-recep tor antagonists is still an alternative approach in some chronic recurrent cases.