Active Duodenal Ulcer Research Articles

Comparison of esomeprazole enteric-coated capsules vs esomeprazole magnesium in the treatment of active duodenal ulcer: A randomized, double-blind, controlled study

To evaluate the efficacy and tolerability of two different preparations of esomeprazole in healing duodenal ulcers. A total of 60 patients with active duodenal ulcers were enrolled and randomized to receive esomeprazole enteric-coated capsules (40 mg) or esomeprazole magnesium (40 mg), once daily, for 4 consecutive wk, with ulcer healing being monitored by endoscopy. Safety and tolerability were also assessed. Fifty seven patients completed the whole trial. The ulcer healing rates at the end of wk 2 were 86.7% and 85.2% in the esomeprazole enteric-coated capsules and esomeprazole magnesium groups, respectively (P = 0.8410), and reached 100% at the end of wk 4 in both groups. Symptom relief at the end of wk 2 was 90.8% in the esomeprazole enteric-coated capsules group and 86.7% in the esomeprazole magnesium group (P = 0.5406); at the end of wk 4 symptom relief was 95.2% and 93.2%, respectively (P = 0.5786). Adverse events occurred in 16.7% of the esomeprazole enteric-coated capsules group and 14.8% of the esomeprazole magnesium group (P = 1.0000). The efficacies of esomeprazole enteric-coated capsules and esomeprazole magnesium in healing duodenal ulcer lesions and relieving gastrointestinal symptoms are equivalent. The tolerability and safety of both drugs were comparable.

One Week of Esomeprazole Triple Therapy vs. 1 Week of Omeprazole Triple Therapy Plus 3 Weeks of Omeprazole for Duodenal Ulcer Healding in Helicobacter pylori-Positive Patients

In this randomized, double-blind, multicenter study, H. pylori-positive patients with an active duodenal ulcer (DU) received esomeprazole, 20 mg twice daily (bid), or omeprazole, 20 mg bid, with amoxicillin, 1000 mg bid, and clarithromycin, 500 mg bid, for 1 week (EAC and OAC, respectively). Patients received an additional 3 weeks of either placebo or omeprazole, 20 mg once daily (od), in the EAC and OAC groups, respectively. The intent-to-treat population included 374 patients (EAC, 186; OAC, 188). Four-week DU healing rates were similar in the EAC+placebo and OAC+omeprazole groups: 74% and 76%, respectively. DU healing rates at 8 weeks were 87% for EAC+placebo and 88% for OAC+omeprazole. H. pylori eradication rates were 75% and 79% for EAC and OAC, respectively. Both regimens were well tolerated. A 1-week regimen of esomeprazole-based H. pylori eradication triple therapy was as effective for DU healing and eradication of H. pylori as omeprazole-based triple therapy followed by an additional 3 weeks of monotherapy.

The Papilla of Vater just below the Pylorus Presenting as Recurrent Duodenal Ulcer Bleeding

The papilla of Vater emptying into the duodenal bulb site is extremely rare and considered an aberrant condition. We report here a case with recurrent duodenal ulcer bleeding associated with this anomaly. A 42-year-old man was admitted to St. Mary Hospital because of tarry stool for three days. Despite no documented etiology to explain recurrent ulceration, the patient had about ten episodes of ulcer bleeding since 1995. On duodenoscopy, 1.0 x 0.6 cm sized active stage duodenal ulcer with oozing was observed at the posterior wall side below the pylorus. The papilla of Vater was bulging just below the pylorus. Bile juice was excreted from its opening. Pancreatic duct and common bile duct, which drained into the bulb site, were observed on ERCP. In this report, we show that recurrent duodenal ulcer can be associated with the papilla of Vater just below the pylorus.

Helicobacter pylori Recurrence in Patients with Duodenal Ulcer: Clinical, Endoscopic, Histologic, and Genotypic Aspects. A 10‐Year Brazilian Series

Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.

Infected Liver Cyst after Adrenaline Injection for Active Duodenal Ulcer

Infected Liver Cyst after Adrenaline Injection for Active Duodenal Ulcer

Genetic relationship among isolates of Helicobacter pylori: evidence for the existence of a Helicobacter pylori species-complex.

We investigated the population genetics of 23 isolates of H. pylori by allozyme electrophoresis using 16 enzyme loci. Isolates were obtained from adult patients of whom 48% were of Greek extraction. Eight patients (35%) had an active duodenal ulcer. Allelic variation per loci ranged from 2 to 11 alleles. Four major genetic clusters were apparent, having > 75% fixed genetic differences. There was no distinct clustering (clonal structure) on the basis of the geographical origin of the persons from whom isolates were obtained, indicating that this bacterium has not recently jumped a species barrier into humans. Isolates associated with ulcer disease were not monophyletic, with isolates from ulcer patients being found in phylogenetically diverse branches of the dendogram derived from the data. Based on the genetic diversity of H. pylori isolates, we propose that isolates should be classified as belonging not to a single species but to a 'Helicobacter pylori species-complex'.

Boerhaave Syndrome Treated Conservatively Following Early Endoscopic Diagnosis: A Case Report

We report on a 41-year-old man with hematemesis and severe epigastric pain. Three hours after the onset of symptoms, we carefully performed upper gastrointestinal endoscopy for suspected upper gastrointestinal perforation. Endoscopy revealed a 2.5-cm-long longitudinal laceration of the lower esophagus without active gastric or duodenal ulcers. The laceration could be partially closed with endoscopic clipping. Computed tomography of the chest revealed a small amount of extraluminal air in the mediastinum. Neither pleural effusion nor pneumothorax was detected. We treated the patient conservatively on the basis of the following factors: a stable general condition without sepsis, limitation of the esophageal disruption to the mediastinum, and early diagnosis. The treatment course was uneventful, and the patient was discharged from the hospital after we had confirmed with endoscopy that the esophageal ulcer was completely healed. Although Boerhaave syndrome is generally considered to have poor prognosis, conservative therapy may be effective in select cases with early detection of the perforation.

Pylorectomy and prepyloric antrectomy for gastric ulcer

From July 1970 to May 1977 79 patients with chronic gastric ulcer were submitted to a pylorectomy and prepyloric antrectomy (only 4--5 cm of the distal stomach being removed). In most, the excision extended in the form of a narrow tongue along the lesser curvature to include the ulcer. Vagotomy was added when signs of a healed or active duodenal ulcer were seen (19 cases). Associated lesions in the distal stomach were detected in 38 more patients. Up to the present no recurrence has been observed and functional results have been satisfactory in 90 per cent of patients. Preliminary results show that this operation produces a satisfactory cure for gastric ulcer, thus making more extensive resections unnecessary.

Intractable Gastrointestinal Ulcers with Bleeding in Behcet's disease-A Case Report with H2-Blocker-Resistance but Successfully Treated with Systemic Steroid and Cytotoxic Agents

A 54-year-old male suffering from repeated massive gastro-duodenal bleeding ulcers, since April 2001, was reported. The ulcers seemed to be resistant to conventional H2-blocker treatment. In the meanwhile, colon ulcer with active bleeding was also present simultaneously. He was diagnosed as having Behcet's disease since three years ago with manifestations of recurrent oral ulcers, genital ulcers, erythema nodosum and folliculitis. Hematemesis, massive tarry stool, bloody stool, high fever, oral ulcers and diffuse lower abdominal pain were noted at this episode. An endoscopic examination revealed active gastric ulcer, duodenal ulcer, and polypoid lesions with ”punch-out” ulcers in the colon. Due to treatment failure with H2-blocker in the previous several bleeding ulcer episodes, methylprednisolone pulse, followed with cyclophosphamide, was prescribed for rescue of active ulcer bleeding. Patient responded well to such management. The endoscopy and colonoscopy one month later after treatment showed complete healing of gastric ulcer and granulation polypoid lesions of colon. There was no more ulcer bleeding up to now in Aug 2004.

Changes in reducing power profile of gastric juice in patients with active duodenal ulcer

Reactive oxygen species have been postulated to play a role in the pathogenesis of mucosal GI injury and in peptic ulcer disease (PUD). The low molecular weight antioxidants (LMWA) group plays an important role in the defense mechanism of the GI tract against oxidative damage, and is a major component of the reducing capacity of biological tissues and fluids. We hypothesized that altered gastric LMWA anti oxidative status might play a role in the pathogenesis of upper GI disorders such as PUD and could be evaluated by measuring gastric juice reducing power. The aim of the present study was to determine, by cyclic voltammetry, changes in the overall antioxidant activity of the gastric juice in active duodenal ulcer (DU) obtained during upper endoscopy from patients as compared with normal subjects. The results show that in 28/37 (76%) of the control subjects, gastric juice demonstrated a reducing power of at least two anodic waves indicating at least two different LMWA groups. Three or more anodic waves were recorded in 12 normal subject (32%). In contrast, 16/25 (64%) of gastric juice samples obtained from active DU patients exhibited only one anodic wave usually at a high potential (> 900 mV). These results imply that gastric juice normally possesses a reducing power profile that can be determined by cyclic voltammetry. This profile is significantly changed in untreated DU disease. These changes in active DU may indicate decreased gastric antioxidant activity reflecting reduced mucosal protection that leading to increased susceptibility of the gastro-duodenum to injury.

The value of brightness ultrasonography examination in patients with duodenal ampulla ulcer

目的 探讨十二指肠球部溃疡患者超声显像的诊断价值.方法对97例经胃镜检查确诊的十二指肠球部溃疡患者应用B超诊断进行观察.结果B超诊断与胃镜检查符合率83.5%,其中B超检出十二指肠球部溃疡直接声像Ⅰ型改变与胃镜符合率96.5%(55/57),均为活动期溃疡;直接征象Ⅱ型改变与胃镜符合率70.0%(28/40),其中活动期溃疡19例,陈旧性溃疡9例.结论十二指肠球部溃疡的超声声像有一定的特异性,与胃镜的符合率较高,可作为十二指肠球部溃疡的辅助诊断方法。

High Eradication Rates of Helicobacter pylori Infection with First- and Second-Line Combination of Esomeprazole, Tetracycline, and Metronidazole in Patients Allergic to Penicillin

H. pylori eradication is a challenge in patients allergic to penicillin, both first-line and failures of prior therapy. We aimed to assess the eradication rate of H. pylori in patients allergic to penicillin, first-line and failures of prior therapy, the efficacy of healing of active duodenal ulcer disease (DUD) and erosive gastritis, and the safety and tolerability of the combination. Twenty patients with documented allergy to penicillin, DUD, and H. pylori infection, 17 (85%) for first-line treatment and 3 (15%) prior therapy failures, were given a 10-day regimen of esomeprazole, 40 mg qid, tetracycline, 500 mg qid, and metronidazole, 500 mg qid. Baseline and follow-up panendoscopy > or =30 days after end of treatment was performed for rapid urease test (Clotest), and four site biopsies for H. pylori, and to document endoscopic peptic ulcer disease. All adverse events during treatment were documented. Eradication rates by intention to treat (ITT) were 85% for first-line treatment and 100% for failures. Seventy percent of all cases had a normal endoscopy at follow-up, and 85 and 100% of patients had healed erosive gastritis and DUD, respectively, from baseline. There were histological improvements in most patients. A high eradication rate was obtained even in patients who had a shorter duration of treatment. The combination was well tolerated. A combination of esomeprazole, tetracycline, and metronidazole is effective for eradication of H. pylori in patients allergic to penicillin, for both first-line treatment and failures of prior treatment.

Helicobacter pylori reinfection rate 3 years after successful eradication

Helicobacter pylori (HP) infection is one of the most prevalent human infections and has been implicated as a predisposing factor in gastric cancer, chronic active gastritis, duodenal ulcer, gastric ulcer and gastric lymphoma. Reinfection after successful eradication is quite uncommon in adults. In the only study carried out in Iran, a reinfection rate of 19.1% after 1 year has been reported. We studied the rate of reinfection 3 years after successful HP eradication. All patients who had undergone HP eradication 3 years before the study and had successful eradication verified by a negative (14)C urea breath test (UBT) 1 year after eradication were invited to complete a questionnaire and undergo another UBT. In addition, spouses and the offspring of those testing positive were offered an UBT. Ninety-eight patients were enrolled (49% male). Mean age was 44 +/- 13 years (range: 18-75 years). Twenty patients (20.4%) had a positive UBT. Epigastric burning (25%vs 69%) and pyrosis (50%vs 67%) were seen less commonly in those who were HP free at 3 years compared to those who tested positive for HP. According to our data, in our region the HP reinfection rate is 20.4% 3 years after successful eradication.

Response of blood endothelin-1 and nitric oxide activity in duodenal ulcer patients undergoingHelicobacter pylorieradication

To investigate the effect of Helicobacter pylori eradication on endothelin-1 (ET-1) and nitric oxide (NO) in duodenal ulcer (DU) patients. Sixty-six H pylori-infected active DU patients were consecutively enrolled to receive one-week triple therapy (rabeprazole, amoxicillin and metronidazole) and then one-month rabeprazole therapy. They were asked back to determine ulcer and H pylori status using endoscopy one month later. Thirty-seven healthy controls (H pylori +/-: 17/20) were enrolled for comparison. Blood samples were collected in each visit to measure plasma ET-1 and nitrate/nitrite levels using an enzyme immunoassay kit. Sixty DU patients finished trial per protocol. The ulcer healing and H pylori-eradication rates were 86.7% and 83.3%, respectively. Plasma ET-1 level in DU patients was higher than that of H pylori-negative and positive controls (3.59+/-0.96 vs 0.89+/-0.54 vs 0.3+/-0.2 pg/mL, P<0.01), while nitrate/nitrite levels among them were also significantly different (8.55+/-0.71 vs 5.27+/-0.68 vs 6.39+/-0.92 mumol/L, P<0.05). H pylori eradication diminished ET-1 levels (3.64+/-0.55 vs 2.64+/-0.55 pg/mL, P<0.01) but elevated nitrate/nitrite level (8.16+/-0.84 vs 11.41+/-1.42 mumol/L, P<0.05). Both plasma ET-1 and nitrate/nitrite levels increase in active DU patients. After an effective H pylori eradication, DU healing is associated with diminished blood ET-1 level and elevated nitrate/nitrite level.

A national survey of primary care physicians' perceptions and practices related to Helicobacter pylori infection.

Our aim was to assess current perceptions and practices of primary care physicians in the United States concerning Helicobacter pylori infection. We mailed a structured questionnaire to approximately 2500 primary care physicians chosen at random from a national database. We asked about personal and practice demographics and practices relating to testing for and treating H. pylori infection. We received 424 responses from 2349 questionnaires (18%). Only 3% each had used either the C- or C-urea breath test; 5% had used the stool antigen test; 92% and 91% recommended testing-and 90% and 82% treatment-for H. pylori in patients with active duodenal and gastric ulcer, respectively. However, only 64% would test for and only 59% would treat H. pylori infection in a patient with past history of duodenal ulcer. Almost half would test patients with gastroesophageal reflux disease being started or maintained on a proton pump inhibitor. The most frequent treatment regimens used were combinations of a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. Most respondents had inaccurate information on antibiotic resistance rates for H. pylori. In the absence of symptoms, 26% would personally undergo testing for H. pylori; 30% would be treated if infected. Primary care physicians usually test for and treat H. pylori infection in patients with active ulcer, but fail to do so in patients with a prior history of ulcer. Some test for H. pylori in gastroesophageal reflux disease patients. Most use efficacious treatment regimens, but have inaccurate information on resistance rates.

Helicobacter pylori and food products: a public health problem.

Helicobacter pylori is a major human pathogen causing gastritis and chronic superficial infection (CSG). It colonizes the stomach of more than 50% of humans and causes disease. This microorganism is associated with the gastric antral epithelium in patients with active chronic gastritis, peptic (gastric) or duodenal ulcers, and gastric adenocarcinoma H. pylori is present in feces, sewage, and water but is killed by routine chlorination. Therefore, in developing countries, consumption of sewage-contaminated drinking water and vegetables may pose a risk; properly cooking foods and chlorinating water reduces the risk of transmitting H. pylori to humans. In South America the consumption of raw vegetables fertilized with human feces has been found to be a risk factor for infection, and consumption of water from a municipal supply has been suggested as a risk factor for children. Epidemiological studies have found that H. pylori organisms colonize the stomach and duodenum of humans and many animal species and family clusters; it is believed to be orally transmitted person to person. This transmission is the major, if not exclusive, source of infection.H. pylori has been detected in the mouth from dental plaque. Recent observations in persons infected with H. pylori caused to vomit or have diarrhea showed that an actively unwell person with these symptoms could spread H. pylori in the immediate vicinity by aerosol, splashing of vomitus, infected vomitus, and infected diarrhea. In summary, H. pylori is usually spread by the fecal-oral route but possibly also by the oral-oral route and the spread of contaminated secretions. Thus, in developing countries, individuals catch H. pylori at a very young age from other persons (children) in their environment. In developed countries, H. pylori is more difficult to acquire and is usually transmitted from one family member to another, possibly by the fecal-oral route, or by the oral-oral route, e.g., kissing, vomitus. On occasion, transmission occurs from person to person via contaminated endoscopes. Other gastric Helicobacter-like organisms have now been observed in a variety of animals, including rodents, primates, swine, and ferrets, but, with the exception of primates and possibly cats, these isolates are clearly different from human isolates. Foodborne transmission would not be unusual.

PARI9: A UTILITY VALUATION STUDY ASSESSING TREATMENT OUTCOMES IN OSTEOARTHRITIS

OA condition: The patient has an OA condition which is being managed with an NSAID. Clinical manifestations of OA can include pain, stiffness and physical disability. Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. GI side-effects: The patient in this health state has symptoms consistent with an NSAID type GI adverse event. The patient is experiencing one of the following NSAID type GI adverse events: acid reflux, heartburn, dyspepsia, epigastric discomfort, nausea or vomiting. Symptoms include burning pains, discomfort, belching and loud intestinal sounds. Other symptoms include a poor appetite, nausea, constipation, diarrhoea and flatulence. Health State C: Patient with OA; Managed with an NSAID; Experiencing an Uncomplicated PUB OA condition: The patient has an OA condition which is being managed with an NSAID. Clinical manifestations of OA can include pain, stiffness and physical disability. Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. GI side-effects: The patient in this health state has symptoms consistent with an uncomplicated PUB. Symptoms may include burning, gnawing, aching, soreness or hunger. The pain associated with symptoms is located in a well defined area and can be mild to moderately severe. The PUB is confirmed by endoscopy, surgery or radiographic results. The PUB is treated on an outpatient basis (potentially with proton pump inhibitors or H2-receptor antagonists). Health State D: Patient with OA; Managed with an NSAID; Experiencing a Complicated PUB OA condition: The patient has an OA condition which is being managed with an NSAID. Clinical manifestations of OA can include pain, stiffness and physical disability. Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. GI side-effects: The patient in this health state has symptoms consistent with a complicated PUB. Symptoms may include burning, gnawing, aching, soreness or hunger. The pain associated with symptoms is located in a well defined area and can be mild to moderately severe. The patient is hospitalised with a gastric or duodenal PUB confirmed by endoscopy, surgery or radiographic results. The confirmed ulcer has one or more of the following clinical features: Active bleeding on visible vessel; Clinically significant upper GI haemorrhage; Obstruction due to active duodenal or gastric ulcer. Depending on the clinical features of the PUB, patients will require different levels of intervention including watchful waiting, drug treatment, surgery and blood transfusion. Health State E: Patient with OA; Managed with paracetamol; Recovering from treatment for a PUB OA condition: The patient has an OA condition which is being managed with paracetamol. The patient has been withdrawn from NSAIDs due to previous GI complications. In this patient population, paracetamol may be less efficacious in the treatment of OA. Consequently, the patient’s OA symptoms may be worse than prior to the PUB. Clinical manifestations of OA can include pain, stiffness and physical disability. Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. GI side-effects: The patient is recovering from a successfully treated PUB. The patient has no GI complications. Health State A: Patient with OA; Managed with an NSAID; No GI complications OA condition: The patient has an OA condition which is being managed with an NSAID. Clinical manifestations of OA can include pain, stiffness and physical disability. Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. GI side-effects: The patient is NOT suffering from any GI complications.

Bismuth-based quadruple therapy using a single capsule of bismuth biskalcitrate, metronidazole, and tetracycline given with omeprazole versus omeprazole, amoxicillin, and clarithromycin for eradication of helicobacter pylori in duodenal ulcer patients: a prospective, randomized, multicenter, north american trial

Objectives This multicenter, randomized, active-controlled trial assessed efficacy of bismuth-based quadruple therapy with omeprazole, bismuth biskalcitrate, metronidazole, and tetracycline (OBMT) using a single-triple capsule of BMT compared with triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) in treatment of patients with Helicobacter pylori infection and duodenal ulcers. Methods Patients with active duodenal ulcer or diagnosed within the past 5 yr and with infection documented by 13C-urea breath test plus histology or culture were randomly assigned to 10-day course of OBMT using a single-triple capsule containing bismuth biskalcitrate 140 mg, metronidazole 125 mg, and tetracycline 125 mg given as three capsules q.i.d. with omeprazole 20 mg b.i.d., or a 10-day course of OAC, omeprazole 20 mg plus amoxicillin 1 g plus clarithromycin 500 mg, all b.i.d. Eradication was confirmed by two negative urea breath tests at >1 month and >2 months after therapy. Results One hundred thirty-eight patients received OBMT and 137 OAC. Modified intent-to-treat eradication rates were 87.7% for OBMT and 83.2% for OAC (95% CI = −3.9%–12.8%; p = 0.29). OBMT eradicated 91.7% metronidazole-sensitive and 80.4% metronidazole-resistant strains ( p = 0.06). OAC eradicated 92.1% clarithromycin sensitive and 21.4% clarithromycin-resistant strains ( p < 0.001). Adverse events occurred in 58.5% of OBMT patients and 59.0% of OAC patients. Conclusions OBMT regimen using the single-triple capsule is as efficacious and well-tolerated as the widely used OAC regimen for H. pylori eradication. This OBMT therapy largely overcomes H. pylori metronidazole resistance, present in 40% of patients in this study.

Density ofHelicobacter pylorimay affect the efficacy of eradication therapy and ulcer healing in patients with active duodenal ulcers

To evaluate the association of pre-treatment Helicobacter pylori (H. pylori) density with bacterial eradication and ulcer healing rates in patients with active duodenal ulcer. One hundred and four consecutive duodenal ulcer outpatients with H. pylori infection ascertained by gastric histopathology and (13)C-urea breath test (UBT) were enrolled in this study. H. pylori density was graded histologically according to the Sydney system (normal, mild, moderate, and marked). In each patient, lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) were used for 1 week, then 30 mg lansoprazole once daily was continued for an additional 3 weeks. Follow-up endoscopy was performed at 4 weeks after completion of the therapy, and UBT was done at 4 and 8 weeks after completion of the therapy. The H. pylori eradication rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 69.7 %/85.2 %; and the ulcer healing rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 63.6 %/77.8 % (intention-to-treat/per protocol analysis) in the mild, moderate, and marked H. pylori density groups, respectively. The association of pretreatment H. pylori density with the eradication rate and ulcer healing rate was both statistically significant (P=0.013/0.006 and 0.002/<0.001, respectively; using results of intention-to-treat/per protocol analysis). Intragastric bacterial load may affect both the outcome of eradication treatment and ulcer healing in patients with active duodenal ulcer disease.

Effect of Helicobacter pylori eradication on development of erosive esophagitis and gastroesophageal reflux disease symptoms: a post hoc analysis of eight double blind prospective studies

OBJECTIVES: The aim of this study was to assess the development of erosive esophagitis, the development of gastroesophageal reflux disease (GERD) symptoms in patients without prior symptomatic or endoscopic GERD, and the worsening of GERD symptoms in patients with prior symptomatic GERD in a post hoc analysis of eight double-blind prospective trials of Helicobacter pylori ( H. pylori) therapy in 1165 patients. METHODS: Patients with active or past duodenal ulcer and without baseline erosive esophagitis had end of study endoscopies 4–30 wk after completion of therapy. A total of 533 patients had heartburn and regurgitation scores assessed at baseline and 4 wk after end of therapy, and were divided into two groups: 1) no prior GERD symptoms (N = 127) and 2) prior GERD symptoms (N = 406). H. pylori was assessed at baseline and ≥4 wk after therapy by rapid urease test, histology, and culture. RESULTS: Erosive esophagitis developed in 24 (4%) of 621 patients with cure versus 14 (3%) of 544 with persistent H. pylori (OR = 1.52, 95% CI = 0.78–2.97). In the longest study (28–30-wk follow-up), esophagitis developed in two (7%) of 28 patients with cure versus five (7%) of 76 with persistent infection. New GERD symptoms developed in 13 (14%) of 92 patients with cure versus seven (20%) of 35 with persistent infection (OR = 0.66, 95% CI = 0.24–1.82). GERD worsened in 20 (7%) of 269 with cure vs 20 (15%) of 137 with persistent H. pylori (OR = 0.47, 95% CI = 0.24–0.91; p = 0.02). CONCLUSIONS: Our results do not support the hypothesis that H. pylori eradication in patients with duodenal ulcer disease leads to the development of erosive esophagitis, the development of new symptomatic GERD, or worsening of symptoms in patients with pre-existing GERD.