H₂- Antagonist Maintenance versus Helicobacter Pylori Eradication Therapy in Patients with Chronic Duodenal Ulcer Disease: A Prospective Study

Background: Few outcome studies directly compare Helicobacter pylori eradication therapy with maintenance H-2-antagonist therapy in duodenal ulcer disease. Aim: TO examine prospectively the efficacy of H. pylori eradication therapy with ranitidine maintenance therapy over 1 year in patients with confirmed chronic duodenal ulcer,

Methods: One hundred and nineteen patients with active H, pylori infection were randomized to receive ranitidine, 150 mg/day initially (58 patients), or omeprazole, 40 mg/day, amoxycillin 2 g/day and metronidazole 1.2 g/day for 14 days, or omeprazole 40 mg/day and clarithromycin 1.5 g/day, for 14 days (if penicillin-allergic). Symptoms were assessed using the Gastrointestinal System Rating Scale (GSRS) and SF36 quality of life index.

Results: C-13 urea breath testing confirmed overall treatment success in 100% of patients (58/58) per protocol and 95.1% (58/61) on an intention-to-treat basis. At 4 and 12 months there were no differences in any GSRS symptoms between treatment groups, SF36 analysis showed a perceived health improvement at 4 and 12 months in patients who received H. pylori eradication. However, despite successful H, pylori eradication, one-fifth of patients still required antisecretory therapy,

Conclusion: Following successful H. pylori eradication, chronic duodenal ulcer patients were at least as well symptomatically as when taking maintenance ranitidine. They perceived that their health had improved, but a subgroup was still acid-suppression dependent.