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Article: Triple therapy for Helicobacter pylori eradication is more effective than long-term maintenance antisecretory treatment in the prevention of recurrence of duodenal ulcer: A prospective long-term follow-up study

TitleTriple therapy for Helicobacter pylori eradication is more effective than long-term maintenance antisecretory treatment in the prevention of recurrence of duodenal ulcer: A prospective long-term follow-up study
Authors
Issue Date1999
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/APT
Citation
Alimentary Pharmacology And Therapeutics, 1999, v. 13 n. 3, p. 303-309 How to Cite?
AbstractBackground: The effectiveness of Helicobacter pylori eradication treatment and long term acid suppression maintenance in the natural course of duodenal ulcer has not been directly compared. Aim: To compare in a prospective randomized study the effectiveness of H. pylori eradication on the prevention of recurrence of duodenal ulcer with long-term maintenance acid suppression therapy. Methods: One hundred and fourteen duodenal ulcer patients were randomized to the treatment over a 12-month period. Fifty-seven of them received triple therapy consisting of 1 g sucralfate q.d.s. for 28 days, 300 mg metronidazole q.d.s. for 14 days and 250 mg clarithromycin q.d.s. for 14 days. Another 57 received 20 mg omeprazole q.d.s. for 12 months. An upper endoscopy was performed before treatment, at 6 weeks, and 2, 6 and 12 months after the first endoscopy. Side-effects were self-recorded and clinical follow-ups were arranged for up to 4.25 years. Results: The ulcer healing rate was 90.2% (95% confidence interval (95% CI): 79-97%) in the omeprazole group at 6 weeks as compared to 83.3% (95% CI: 70-93%) in the triple therapy group (P = 0.38). There was a higher success rate of pain control in the omeprazole group. Side-effects were more frequently reported and compliance was poorer in the triple therapy group during the first 4 weeks. During follow-up, more relapses were seen in the omeprazole group (9.8%, 95% CI: 3-21%) than the triple therapy group (4.2%, 95% CI: 1-13%) at 1 year (P = 0.44). All relapses were due to the persistence of H. pylori infection. At the 1 year follow-up, none of the patients who were H. pylori negative had an endoscopic relapse compared to 7 out of 56 patients who remained H. pylori positive (12.5%, 95% CI: 5-24%, P = 0.018). After a mean follow-up of 4.07 years, none of those who remained H. pylori negative had an ulcer relapse while the 11 out of 41 who remained H. pylori positive had an ulcer relapse (26.8%, 95% CI 14-43, P = 0.0005). Conclusions: Both regimens were highly effective in healing ulcers. The eradication of H. pylori infection was associated with more side-effects and poor compliance but was more effective than the maintenance therapy in reducing the recurrence of duodenal ulcers. For the prevention of ulcer recurrence, testing of H. pylori status after triple therapy is more important than maintenance therapy.
Persistent Identifierhttp://hdl.handle.net/10722/162270
ISSN
2015 Impact Factor: 6.32
2015 SCImago Journal Rankings: 2.833
References

 

DC FieldValueLanguage
dc.contributor.authorWong, BCYen_US
dc.contributor.authorLam, SKen_US
dc.contributor.authorLai, KCen_US
dc.contributor.authorHu, WHCen_US
dc.contributor.authorChing, CKen_US
dc.contributor.authorHo, Jen_US
dc.contributor.authorYuen, STen_US
dc.contributor.authorChan, CKen_US
dc.contributor.authorLau, GKKen_US
dc.contributor.authorLai, CLen_US
dc.date.accessioned2012-09-05T05:18:33Z-
dc.date.available2012-09-05T05:18:33Z-
dc.date.issued1999en_US
dc.identifier.citationAlimentary Pharmacology And Therapeutics, 1999, v. 13 n. 3, p. 303-309en_US
dc.identifier.issn0269-2813en_US
dc.identifier.urihttp://hdl.handle.net/10722/162270-
dc.description.abstractBackground: The effectiveness of Helicobacter pylori eradication treatment and long term acid suppression maintenance in the natural course of duodenal ulcer has not been directly compared. Aim: To compare in a prospective randomized study the effectiveness of H. pylori eradication on the prevention of recurrence of duodenal ulcer with long-term maintenance acid suppression therapy. Methods: One hundred and fourteen duodenal ulcer patients were randomized to the treatment over a 12-month period. Fifty-seven of them received triple therapy consisting of 1 g sucralfate q.d.s. for 28 days, 300 mg metronidazole q.d.s. for 14 days and 250 mg clarithromycin q.d.s. for 14 days. Another 57 received 20 mg omeprazole q.d.s. for 12 months. An upper endoscopy was performed before treatment, at 6 weeks, and 2, 6 and 12 months after the first endoscopy. Side-effects were self-recorded and clinical follow-ups were arranged for up to 4.25 years. Results: The ulcer healing rate was 90.2% (95% confidence interval (95% CI): 79-97%) in the omeprazole group at 6 weeks as compared to 83.3% (95% CI: 70-93%) in the triple therapy group (P = 0.38). There was a higher success rate of pain control in the omeprazole group. Side-effects were more frequently reported and compliance was poorer in the triple therapy group during the first 4 weeks. During follow-up, more relapses were seen in the omeprazole group (9.8%, 95% CI: 3-21%) than the triple therapy group (4.2%, 95% CI: 1-13%) at 1 year (P = 0.44). All relapses were due to the persistence of H. pylori infection. At the 1 year follow-up, none of the patients who were H. pylori negative had an endoscopic relapse compared to 7 out of 56 patients who remained H. pylori positive (12.5%, 95% CI: 5-24%, P = 0.018). After a mean follow-up of 4.07 years, none of those who remained H. pylori negative had an ulcer relapse while the 11 out of 41 who remained H. pylori positive had an ulcer relapse (26.8%, 95% CI 14-43, P = 0.0005). Conclusions: Both regimens were highly effective in healing ulcers. The eradication of H. pylori infection was associated with more side-effects and poor compliance but was more effective than the maintenance therapy in reducing the recurrence of duodenal ulcers. For the prevention of ulcer recurrence, testing of H. pylori status after triple therapy is more important than maintenance therapy.en_US
dc.languageengen_US
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/APTen_US
dc.relation.ispartofAlimentary Pharmacology and Therapeuticsen_US
dc.rightsAlimentary Pharmacology and Therapeutics. Copyright © Blackwell Publishing Ltd.-
dc.subject.meshAdulten_US
dc.subject.meshAnti-Bacterial Agents - Adverse Effects - Therapeutic Useen_US
dc.subject.meshAnti-Ulcer Agents - Adverse Effects - Therapeutic Useen_US
dc.subject.meshBreath Testsen_US
dc.subject.meshClarithromycin - Adverse Effects - Therapeutic Useen_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshDuodenal Ulcer - Drug Therapy - Microbiology - Prevention & Controlen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHelicobacter Infections - Drug Therapy - Microbiologyen_US
dc.subject.meshHelicobacter Pylori - Drug Effectsen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMetronidazole - Adverse Effects - Therapeutic Useen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshOmeprazole - Adverse Effects - Therapeutic Useen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRecurrence - Prevention & Controlen_US
dc.subject.meshSucralfate - Adverse Effects - Therapeutic Useen_US
dc.subject.meshUrea - Metabolismen_US
dc.titleTriple therapy for Helicobacter pylori eradication is more effective than long-term maintenance antisecretory treatment in the prevention of recurrence of duodenal ulcer: A prospective long-term follow-up studyen_US
dc.typeArticleen_US
dc.identifier.emailWong, BCY:bcywong@hku.hken_US
dc.identifier.emailLai, CL:hrmelcl@hku.hken_US
dc.identifier.authorityWong, BCY=rp00429en_US
dc.identifier.authorityLai, CL=rp00314en_US
dc.description.naturelink_to_OA_fulltexten_US
dc.identifier.doi10.1046/j.1365-2036.1999.00477.xen_US
dc.identifier.pmid10102962en_US
dc.identifier.scopuseid_2-s2.0-0032587351en_US
dc.identifier.hkuros40864-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0032587351&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume13en_US
dc.identifier.issue3en_US
dc.identifier.spage303en_US
dc.identifier.epage309en_US
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridWong, BCY=7402023340en_US
dc.identifier.scopusauthoridLam, SK=7402279473en_US
dc.identifier.scopusauthoridLai, KC=7402135595en_US
dc.identifier.scopusauthoridHu, WHC=25932937100en_US
dc.identifier.scopusauthoridChing, CK=7102130825en_US
dc.identifier.scopusauthoridHo, J=15029093800en_US
dc.identifier.scopusauthoridYuen, ST=8323342200en_US
dc.identifier.scopusauthoridChan, CK=7404813824en_US
dc.identifier.scopusauthoridLau, GKK=7102301257en_US
dc.identifier.scopusauthoridLai, CL=7403086396en_US
dc.customcontrol.immutablejt 130710-

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