ERADICATION AND RE-INFECTION OF HELICOBACTER PYLORI IN DUODENAL ULCER

Abstract

Herein we compare the eradication and re-infection rates of triple anti-helicobacter pylori therapy which consists of bismuth subsalicylate, metronidazole and amoxillin with dual therapy which consists of omeprazole plus amoxycillin.

Current therapy of duodenal ulcer provides relief of symptoms and prevention of recurrences. Anti-helicobacter plori eradlication is known to reduce recurrences significantly (1, 2, 3, 4, 5). Various combination therapies are used for eradication, and difference in eradication and re-infection rate of the individual therapy is observed.

Three hundred thirty three duodenal ulcer patients with positive HP were divided into two groups: Group I (n=230) which was given triple therapy, and Group II which was given dual therapy. Duration for both therapies was two weeks. All patients were called for re-examination by endoscopy 2 weeks after anti-HP therapy and patients found to be negative were called for re-examination 8 weeks after cessation of the therapy, and all HP negatives found during this examination were called after 28 weeks for endoscopy. Six week famotidin regimen was started two weeks after completion of anti-HP therapy. During re-examinations antral biopsy specimen was obtained and ulcer healing was observed. HP infection diagnosis were made by rapid urease activity or staining specimen by modified Giemsa.

After 2 weeks 181 out of 230 patients (78%) in Group I and 77 out of 113 patients (68%) in Group II were HP negative. After 8 weeks and 28 weeks these rates were found to be 70 % (n=128) vs. 42% (n=33) and 67% vs. 12% in Group I and Group II respectively (p<0.05 for both periods). The difference in eradication after 2 weeks was not significant, but the difference found on 8 and 28th weeks were significant. Ulcer healing observed on 2 week after therapy was not significant. Cumulative re-infection rate after 28 weeks was 52% in Group I and 94% in Group II (p<0.05).

These results suggest that triple therapy is superior to the dual therapy in terms of HP eradication. No difference in ulcer healing was observed between groups before starting famotidin regimen. Re-infection rates were high after both regimens but significantly higher in Group II.

This high rate of re-infection may be recrudescence of the organism after an inactivation period following anti-HP therapy rather than real re-infection.