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The effect of antibiotic therapy on bleeding from duodenal ulcer
A Sonnenberg1, C A Olson, J Zhang
1Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque 87108, USA.
Insights
Eradicating Helicobacter pylori (H. pylori) infection with antibiotics like clarithromycin and omeprazole effectively prevented duodenal ulcer bleeding. This H. pylori treatment significantly reduced hemorrhage risk in ulcer patients.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Clinical Medicine
Background:
- Duodenal ulcers are a common gastrointestinal condition.
- Helicobacter pylori (H. pylori) infection is a major risk factor for duodenal ulcers.
- Ulcer-related hemorrhage is a serious complication of duodenal ulcers.
Purpose of the Study:
- To determine if eradicating H. pylori infection prevents duodenal ulcer hemorrhage.
- To compare the efficacy of different treatment regimens in preventing ulcer bleeding.
Main Methods:
- Four randomized, double-blind, multicenter studies were conducted.
- Patients with H. pylori and duodenal ulcers received clarithromycin plus omeprazole, omeprazole alone, or ranitidine alone.
- H. pylori eradication was confirmed using the 13C-urea breath test, with 1-year follow-up for hemorrhage.
Main Results:
- No duodenal ulcer bleeding occurred in patients treated with clarithromycin plus omeprazole.
- Five patients (omeprazole alone) and six patients (ranitidine alone) experienced ulcer-related hemorrhage.
- H. pylori eradication rates were 68% for clarithromycin/omeprazole, 5% for omeprazole, and 4% for ranitidine.
Conclusions:
- Antibiotic eradication of H. pylori infection prevents ulcer-related hemorrhage in duodenal ulcer patients.
- H. pylori suppression also demonstrated a preventive effect on hemorrhage.
- Treatment with clarithromycin plus omeprazole was highly effective in eradicating H. pylori and preventing bleeding.
Objective:
We conducted this study to test whether eradication of Helicobacter pylori (H. pylori) infection prevents hemorrhage related to duodenal ulcer.
Methods:
Patients with H. pylori infection and endoscopically proven duodenal ulcers without ulcer-related hemorrhage were enrolled into four randomized, double-blind, multicenter studies using the same study protocol. They were treated with clarithromycin plus omeprazole (441 patients), omeprazole alone (447 patients), or ranitidine alone (263 patients). Success of H. pylori eradication was evaluated by the 13C-urea breath test 4-6 wk after the last dose of study drug. Follow-up continued at monthly intervals up to 1 yr after the last dose of study drug.
Results:
Bleeding due to duodenal ulcer was not observed in any patients who received clarithromycin plus omeprazole, whereas five patients in the omeprazole treatment group and six patients in the ranitidine treatment group experienced an episode of ulcer-related hemorrhage during follow-up. All patients who experienced ulcer-related bleeding were male. When compared by bleeding, there were no significant differences with respect to ethnicity, alcohol consumption, or tobacco use. H. pylori infection was no longer detectable in 68% of patients after treatment with clarithromycin plus omeprazole, compared with 5% after treatment with omeprazole alone or 4% after treatment with ranitidine alone.
Conclusion:
In a population of duodenal ulcer patients without predisposing risk factors for ulcer bleeding, antibiotic eradication or suppression of H. pylori infection prevented the occurrence of ulcer-related hemorrhage for up to 1 yr after therapy.