Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage - A long-term randomized, controlled study

OBJECTIVE: Eradication of Helicobacter pylori (H. pylori) in patients with uncomplicated duodenal ulcers prevents longterm recurrence of ulcers. We ai med to study whether treatment of H. pylori prevents the long-term recurren ce of duodenal ulcer hemorrhage. METHODS: Patients with duodenal ulcer bleeding and confirmed H. pylori infe ction were recruited. A total of 120 patients were randomly assigned to tri ple therapy (DeNoltab 120 mg, amoxycillin 500 mg, and metronidazole 300 mg four times daily) or DeNoltab 120 mg four times daily alone. No maintenance therapy was given during the follow-up period. The endpoints were the cumu lative rates of symptomatic and bleeding duodenal ulcer recurrences. RESULTS: Of the patients receiving the triple regimen, 85.1% had H. pylori eradicated as compared to 2.0% of patients receiving DeNoltab (p < 0.05). M ore patients in the DeNoltab group than those in the Triple group had recur rence of ulcer bleeding, but this did not reach statistical significance (1 2/60 vs 6/60, p = 0.20). Logistic regression analysis on clinical, personal , and endoscopic characteristics identified persistent H. pylori infection as the only independent predictor of recurrence of duodenal ulcer bleeding. CONCLUSIONS: Treatment of H. pylori alone with the present bismuth-based tr iple therapy in patients with duodenal ulcer hemorrhage did not result in s ignificant reduction in further bleeding episodes, although a trend was see n for the group that was given triple therapy. On the other hand, posttreat ment H. pylori status was found to be an independent predictor of bleeding recurrence. (Am J Gastroenterol 2000;95:2225-2232. (C) 2000 by Am. Cell. of Gastroenterology).