Prolonging proton pump inhibitor-based anti-Helicobacter pylori treatment from one to two weeks in duodenal ulcer: is it worthwhile?

Aims. To compare the efficacy of one-week versus two-week treatment with la nsoprazole, amoxycillin and clarithromycin in inducing healing of Helicobac ter pylori-positive duodenal ulcers as well as to investigate the role of s everal factors, determinant in the ulcer healing process. Patients and methods. Seventy-one active duodenal ulcer patients were rando mised to receive one- or two-week treatment with lansoprazole (30 mg bid), clarithromycin (500 mg bid) and amoxycillin (1 g bid), not followed by any additional acid suppressive therapy. Ulcer healing and Helicobacter pylori infection were assessed by endoscopy and urea breath test 4 weeks after the end of treatment. Before entering the trial and four weeks after the end o f treatment, dyspeptic symptoms were recorded and scored by a validated que stionnaire. The potential effects of a number of clinical variables on the ulcer healing process were evaluated by means of univariate and multivariat e analyses. Results. Duodenal ulcer was healed in 80.5% patients treated for one week a nd in 91.4% patients treated for 2 weeks according to intention-to-treat an alysis (p=NS). Ulcer healing was more frequent in the Helicobacter pylori c ured patients compared to those with persisting infection (90.9% vs 68.5%; p=0.04). Multivariate analysis did not reveal any significant predictor of duodenal ulcer healing. Conclusions. Two-week treatment with lansoprazole, amoxycillin and clarithr omycin, without continuation of antisecretive therapy, is better: although the difference is not statistically significant, than one-week treatment in healing Helicobacter pylori-positive duodenal ulcer disease. The eradicati on of Helicobacter pylori is the most important factor related to ulcer hea ling.