Recurrence Rate Of Peptic Ulcer Research Articles

Vonoprazan prevents low-dose aspirin-associated ulcer recurrence: randomised phase 3 study

ObjectiveCompare efficacy and safety of vonoprazan and lansoprazole for secondary prevention of low-dose aspirin (LDA)-associated peptic ulcers in a 24-week study and long-term extension therapy in separate study.DesignDouble-blind, randomised, non-inferiority...

Diagnosis and Treatment of Peptic Ulcer Disease: Present and Future Perspective

Peptic ulcer disease is one of the most commonly encountered diseases in gastroenterology clinics. After the discovery of Helicobacter pylori by Warren and Marshall, it has been identified as the most important cause of peptic ulcer. Eradication of H. pylori markedly reduces the post-treatment recurrence rate of peptic ulcer. However, as human populations age, the incidence of cardiovascular and musculoskeletal diseases increases and consequent use of aspirin and non-steroidal anti-in-flammatory drugs increases. Thus causes and presenting patterns of peptic ulcer have changed. In this review, I describe new diagnostic and therapeutic strategies for peptic ulcer disease and explore future perspectives.

Curative effect and safety of the adjuvant therapy of bifidobacterium bifidum-sine capsules to helicobacter pylori positive peptic ulcer

Objective To discuss the curative effect and safety of the adjuvant therapy （ AT） of bifidobacteri-um bifidum-sine capsules to helicobacter pylori （ HP） positive peptic ulcer .Methods 76 HP infected peptic ulcer patients were selected and divided into the observation group and control group at random .The patients in control group were given traditional triple therapy of omeprazole ,amoxicillin and carat enzyme for 4 weeks,while the patients in observation group were given bifidobacterium bifidum-sine capsules（420mg） three times daily for 4 weeks.Clinical symptom remission,ulcer healing and HP clearance of patients in two groups were observed and compared .The inci-dence rate of drug adverse reaction （ DAR） during treatment period was observed ,and the recurrence rates of peptic ulcer within half a year and one year were followed up .Results The HP clearance rate of the observation group was significantly higher than control group （χ2 =4.21,P〈0.05）.The incidence rate of DAR of the observation group was 10.26%,which was significantly lower than 29.73%of the control group （χ2 =4.55,P〈0.05）.34 cases in the ob-servation group and 30 cases in the control group were healed ,these patients were followed up for half a year and one year,and the recurrence rate of peptic ulcer in observation group was significantly lower than that in control group （χ2 =4.51,5.23,all P〈0.05）.Conclusion The bifidobacterium bifidum-sine capsules combined with PPI triple therapy,can increase the eradication rate of HP ,reduce DAR and the recurrence rate of ulcer . Key words: Peptic ulcer; Helicobacter pylori （ HP）; Bifidobacterium bifidum-sine capsules; Curative effect; Security

Helicobacter pylori and Nonmalignant Diseases

AbstractDeclining Helicobacter pylori prevalence rates have resulted in a decrease of peptic ulcer bleeding incidence. Moreover, eradication reduces peptic ulcer recurrence rate. Newer studies confirm that H. pylori eradication lowers the risk of recurrent peptic ulcer bleeding. Guidelines therefore advocate a test‐and‐treat strategy for patients with a history of ulcer bleeding and NSAIDs and/or aspirin use. There is mounting evidence that H. pylori status has no effect on symptoms and treatment efficacy in patients with gastroesophageal reflux disease (GERD). Some studies observed an improvement of GERD complaints after H. pylori eradication, which underlines that H. pylori treatment is not contra‐indicated in GERD patients. The exact role of H. pylori in functional dyspepsia (FD) remains controversial. However, there is growing consensus that H. pylori‐positive FD should be assessed as a separate entity. In these patients, eradication can be beneficial and appropriate. Finally, several studies suggest that H. pylori infection may also be associated with beneficial effects for the host. Epidemiologic studies showed an inverse relation between H. pylori infection and asthma and allergy, although data are conflicting and need to be expanded.

Recent Six-Year Experiences of PPI-Based Triple Therapy of Heliobacter pylori

Purpose: The success rate of Proton pump inhibitor (PPI) based triple therapy for Heliobacter pylori eradication has been decreased recently. The aim of this study was to evaluate the recent 6-year experience of the eradication and the reinfection rates after the successful eradication of H. pylori infection in a single center of Korea. Methods: From March 2002 to April 2008, 584 patients with H. pylori-positive peptic ulcer disease and gastritis received the PPI-based triple therapy for 7 days (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). 13C-urea breath test was assessed to determine the H. pylori status after the eradication. The 83 patients with mean 1.2-years follow-up after the successful eradication were included. The eradication rate and the effect of age, gender, activity and the location of ulcer and the types of PPI were examined. Results: The overall H. pylori eradication rate was 83.7%. Annual success rate of H. pylori eradication from year 2003 to 2007 tended not to be decreased (95.7, 86.6, 80.7, 83.5, and 86%, respectively). The eradication rate was not different according to types of PPI (lansoprazole vs. omeprazole vs. rabeprazole; 82.6, 86.2, 84.7%, respectively). There were also no significant difference in eradication rate according to gender, age, the activity and location of the ulcer. The cumulative reinfection rate and the recurrence rate of peptic ulcer was 6.0% and 18.3% during mean 1.2 year follow up period. However, the recurrence of the disease was not associated with the status of H. pylori infection. Conclusion: PPI-based triple therapy seems to be still effective for the first-line therapy of H. pylori eradication. However a new treatment regime should be developed to overcome the lower eradication rate.

Recurrent peptic ulcers in patients following successful Helicobacter pylori eradication: a multicenter study of 4940 patients.

Although curative treatment of Helicobacter pylori infection markedly reduces the relapse of peptic ulcers, the details of the ulcers that do recur is not well characterized. The aim of this study is to describe the recurrence rate and specific features of peptic ulcers after cure of H. pylori infection. This was a multicenter study involving 4940 peptic ulcer patients who were H. pylori negative after successful eradication treatment and were followed for up to 48 months. The annual incidence of ulcer relapse in H. pylori-cured patients, background of patients with relapsed ulcers, time to relapse, ulcer size, and site of relapsed ulcers were investigated. Crude peptic ulcer recurrence rate was 3.02% (149/4940). The annual recurrence rates of gastric, duodenal and gastroduodenal ulcer were 2.3%, 1.6%, and 1.6%, respectively. Exclusion of patients who took NSAIDs led annual recurrence rates to 1.9%, 1.5% and 1.3%, respectively. The recurrence rate was significantly higher in gastric ulcer. Recurrence rates of patients who smoked, consumed alcohol, and used NSAIDs were significantly higher in those with gastric ulcer recurrence compared to duodenal ulcer recurrence (e.g. 125 of 149 [83.9%] relapsed ulcers recurred at the same or adjacent sites as the previous ulcers). Curative treatment of H. pylori infection is useful in preventing ulcer recurrence. Gastric ulcer is more likely to relapse than duodenal ulcer. Recurrent ulcer tended to recur at the site of the original ulcers.

Role of Helicobacter pylori infection in perforation of peptic ulcer: an age- and gender-matched case-control study.

Evidence showed a marked decrease in recurrence rate of peptic ulcer after eradication of Helicobacter pylori infection. However, whether H. pylori infection is etiologically related to perforation of peptic ulcer remains to be clarified. We therefore conducted an age- and gender-matched case-control study between perforated and nonsurgical peptic ulcers in H. pylori infection and examined differences in the cytotoxin genes cagA and vacA. Serum H. pylori IgG antibody (ELISA) was positive in 20/21 (95%) of perforated vs. 37/40 (93%) of nonsurgical duodenal ulcers and in 5/5 (100%) of perforated vs. 24/28 (86%) of nonsurgical gastric ulcer patients. Positivity of H. pylori DNA in gastric juice, which was amplified by PCR and identified by Southern blot hybridization, was 17/23 (74%) of perforated vs. 32/45 (71%) in the nonsurgical duodenal ulcer group. Positivity of the cytotoxin genes cagA and vacA in H. pylori DNA-positive gastric juice was as follows: perforated vs. nonsurgical duodenal ulcer, cagA 11/ 13 (85%) vs. 24/27 (89%); vacA1: 9/13 (69%) vs. 22/27 (82%); vacA2 8/13 (62%) vs. 21/27 (78%). There were no significant differences between the perforated and nonsurgical peptic ulcer groups for these H. pylori serum and gene markers. It is assumed that H. pylori infection is not etiologically related to perforation of peptic ulcer.

Smoking and Peptic Ulcer Review of Recent Literature

A higher incidence of peptic ulcer has been found in smokers than in non-smokers, and a higher percentage of smokers has been found in patients with peptic ulcer. Higher rates of healing of peptic ulcers have been reported for non-smokers than for smokers in some studies. Authors agree that smokers have an increased recurrence rate of peptic ulcer after healing compared with non-smokers. Further studies on these problems should be performed in larger prospective studies designed for the purpose.

Surgical management of peptic ulcer

1. 1. 54.0 per cent of 211 patients with peptic ulcer had either acute or chronic gastrointestinal hemorrhage preoperatively. 49.0 per cent of the patients with preoperative bleeding had massive bleeding and required five or more units of whole blood. 2. 2. 94.7 per cent of 211 consecutive patients with peptic ulcer underwent vagotomy with a drainage procedure as definitive therapy. 3. 3. Six patients (2.7 per cent) died postoperatively, although in only two (0.9 per cent) patients could death be classified due to operative failure since fatal hemorrhage recurred. 4. 4. The current status is known in 96.6 per cent (198) of 205 patients. 49.7 per cent of 205 postoperative patients have been followed up from five to nineteen years. The longest follow-up period is in excess of nineteen years and concerns a patient who underwent vagotomy and gastroenterostomy for severe bleeding in 1949. 5. 5. The proved peptic ulcer recurrence rate is 1.9 per cent (four patients) of 205 patients. The possible recurrence is 2.9 per cent (six patients) and the combined total is 4.8 per cent. There was no recurrence of gastric ulcer in twenty-seven patients or in ten additional patients with simultaneous gastric and duodenal ulcer. These data strongly support vagotomy with a drainage procedure for the following conditions: (1) acute and chronic duodenal ulcer, including massive hemorrhage; (2) benign gastric ulcer; (3) simultaneous duodenal and gastric ulcer.