Helicobacter pylori eradication therapy is more effective in peptic ulcer than in non-ulcer dyspepsia

Aim To evaluate whether eradication therapy is more effective in peptic ulc er disease (PUD) than in non-ulcer dyspepsia (NUD). Methods We retrospectively studied 481 patients with NUD (183 patients) or PUD (298 patients) infected with Helicobacter pylori included in several pr ospective clinical trials. Three eradication regimens were given: (1) proto n pump inhibitor (PPI) plus clarithromycin, plus either amoxycillin or metr onidazole for 7 days (297 patients); (2) ranitidine bismuth citrate (RBC) p lus clarithromycin plus amoxycillin for 7 days (79 patients); and (3) RBC p lus clarithromycin plus amoxycillin plus metronidazole for 5 days (105 pati ents). H. pylori eradication was defined as a negative C-13-urea breath tes t 4 weeks after completing treatment. Results H. pylori eradication rates were 82% (95% Cl 78-87%) with PPI plus two antibiotics for 7 days, 85% (95% Cl 75-91 %) with RBC plus two antibiot ics for 7 days, and 91% (95% Cl 86-97%) with RBC plus three antibiotics for 5 days (P < 0.05 compared with the first regimen). Overall, the H. pylori eradication rate in patients with NUD was 78% (95% Cl 71-84%), while in pat ients with PUD it was 89% (95% Cl 86-93%) (P < 0.001). Both the combination of PPI plus two antibiotics for 7 days and the combination of RBC plus thr ee antibiotics for 5 days were more effective in PUD than in NUD patients. However, RBC plus clarithromycin plus amoxycillin for 7 days was equally ef fective in both diseases. RBC plus two antibiotics for 7 days achieved bett er results than the same therapy with PPI only in NUD patients (84% v. 59%, P < 0.01), but both regimens were similar when prescribed in PUD patients (86% v. 88%). In the multivariate analysis, the type of therapy, the diagno sis (NUD v. PUD), and the product variable of therapy (with RBC plus 2 anti biotics for 7 days) and diagnosis (interaction variable) were the only vari ables that influenced H. pylori eradication. The odds ratio (OR) for the ef fect of RBC versus PPI plus two antibiotics for 7 days in patients with NUD was 4 (95% Cl 1.7-9.7; P < 0.01), whereas in patients with PUD no statisti cal significance was achieved (OR 0.79; 95% Cl 0.2-3.9). Conclusion Overall, H. pylori eradication therapy is more effective in PUD than in NUD patients. This advantage of eradication therapies in PUD patien ts seems to be observed with 7-day PPI-based triple regimens, and with 5-da y RBC-based quadruple therapy, while the 7-day RBC-based triple regimen see ms to be equally effective in both diseases. (C) 2001 Lippincott Williams & Wilkins.