[Efficacy of quadruple therapy in the eradication of Helicobacter pylori and prevention of recurrent duodenal ulcer].

OBJECTIVE

We studied during a 12-months follow-up the effect of the eradication of Helicobacter pylori (Hp) on the recurrence of duodenal ulcer (DU).

BACKGROUND

The eradication of Hp from the gastric mucosa has been the objective of numerous therapeutic trials for preventing DU recurrence; however, an optimal treatment has not yet been established.

METHODS

51 patients with Hp infection and active DU confirmed by endoscopy were randomized in two groups. All patients received ranitidine 300 mg daily for eight weeks. Group A (26 patients) received a 5 day course of amoxycillin 500 mg t.i.d., metronidazole 500 mg t.i.d., and furoxone 100 mg t.i.d., during the 3rd week. After ranitidine treatment, none patient of this group received further treatment. Group B (25 patients) received 150 mg of ranitidine daily during 12 months. Endoscopy was performed at the end of the first eight weeks of the ranitidine treatment as well as at the 6th and 12th month of follow-up or sooner if symptoms recurred. Two biopsies were taken from gastric antrum at each endoscopy examination for Hp detection with Giemsa and hematoxylin/eosine stains. Each patient gave informed consent and this trial was approved by the regional Ethics Committee. Statistical analysis was performed using chi 2 test.

RESULTS

After eight weeks of ranitidine treatment, the ulcer of all patients from both groups was healed. The percentage of Hp eradication was 92% (24/26 pt) in group A and none in group B (p < 0.001). Recurrence of Hp infection occurred in 9/24 patients (37.5%) during a 12 months follow-up (group A) and of these, one patient had recurrence of DU. In contrast, all 25 patients of group B were persistently Hp positive and 7 developed recurrent DU (p < 0.05). Both treatments were well tolerated.

CONCLUSIONS

The combined therapy with amoxycillin, metronidazole, furoxone and ranitidine is highly effective in both Hp eradication and prevention of DU recurrence.