Helicobacter pylori eradication with bismuth subnitrate, oxytetracycline and metronidazole in patients with peptic ulcer disease.

A total of 152 patients with recurrent peptic ulcer disease were treated with bismuth subnitrate, oxytetracycline and metronidazole. The 51 patients in Group 1 were included following a study of the effect of cognitive psychotherapy on the recurrence rate after curative treatment for duodenal ulcer (DU). Group 2 comprised 101 consecutive patients referred to us with recurrent peptic ulcer. Their Helicobacter pylori (Hp) status was assessed before, and 4 weeks after, discontinuation of treatment, using the 14C-urea breath test. The primary aim of the study was to determine the effect of the triple treatment regimen on Hp eradication. All but two patients were Hp-positive prior to treatment. Four weeks after termination of treatment, Hp was found to have been eradicated in 50 out of 51 patients (98%) in Group 1, and in 86 out of 97 patients (89%) in Group 2. The respective ulcer healing rates for the two groups were 100% and 95%. Fifty percent of the patients noted moderate to severe adverse effects, mainly nausea and diarrhea, but only 5 patients discontinued treatment prematurely. The results indicate that virtually all patients with recurrent peptic ulcer disease have gastric Hp infection, and that the present triple treatment is highly effective in terms of both Hp eradication and ulcer healing.