85674
document
Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer . BACKGROUND Persistent infection with Helicobacter pylori is associated with the recurrence of duodenal ulcer . Whether the efficacy of bismuth therapy in reducing the rate of recurrence of duodenal ulcer is due to its antimicrobial effects on H. pylori or to a direct protective action on the mucosa is still a matter of debate . METHODS To study the effect of the eradication of H. pylori on the recurrence of duodenal ulcer , we treated 104 patients with H. pylori infection and recurrent duodenal ulcer with either amoxicillin ( 750 mg three times daily ) plus metronidazole ( 500 mg three times daily ) or identical-appearing placebos , given orally for 12 days . All patients also received ranitidine ( 300 mg each night ) for 6 or 10 weeks . Endoscopy was performed before treatment and periodically during follow-up for up to 12 months after healing . RESULTS Among the 52 patients given antibiotics , H. pylori was eradicated in 46 , as compared with 1 of the 52 given placebo ( 89 percent vs. 2 percent , P < 0.001 ) . After six weeks , the ulcers were healed in 48 patients given antibiotics and 39 given placebo ( 92 percent vs. 75 percent , P = 0.011 ) . Side effects , mainly diarrhea , occurred in 15 percent of the patients given antibiotics . Among the patients followed up for 12 months , duodenal ulcers recurred in 4 of 50 patients given antibiotics and 42 of 49 given placebo ( 8 percent vs. 86 percent , P < 0.001 ) . Ulcers recurred in 1 of 46 patients in whom H. pylori had been eradicated , as compared with 45 of 53 in whom H. pylori persisted ( 2 percent vs. 85 percent , P < 0.001 ) . CONCLUSIONS In patients with recurrent duodenal ulcer , eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence , suggesting a causal role for H. pylori in recurrent duodenal ulcer .
85675
Intervention_Pharmacological
ranitidine
85676
Intervention_Pharmacological
amoxicillin
85677
Intervention_Pharmacological
metronidazole
85678
Intervention_Pharmacological
amoxicillin
85679
Intervention_Pharmacological
metronidazole
85680
Intervention_Control
identical-appearing placebos
85681
Intervention_Pharmacological
ranitidine
85682
Intervention_Pharmacological
antibiotics
85683
Intervention_Control
placebo
85684
Intervention_Pharmacological
antibiotics
85685
Intervention_Control
placebo
85686
Intervention_Pharmacological
antibiotics
85687
Intervention_Pharmacological
antibiotics
85688
Intervention_Control
placebo
85689
Outcome_Other
eradicated
85690
Outcome_Other
healed
85691
Outcome_Adverse-effects
diarrhea
85692
Outcome_Physical
duodenal ulcers recurred
85693
Outcome_Physical
Ulcers recurred
85694
Outcome_Other
eradication
85695
Participant_Sample-size
104
85696
Participant_Condition
H. pylori infection
85697
Participant_Condition
recurrent duodenal ulcer
85698
Participant_Sample-size
52
85699
Participant_Condition
recurrent duodenal ulcer