Diagnosis and eradication of helicobacter pylori in patients with duodenal ulceration in the community

To determine the value of Helicobacter pylori [Hp] serology in diagnosis of active Hp infection in patients with documented duodenal ulcer [DU] and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. Prospective, single-blinded, randomised trial. One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test [UBT]. Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs [OCM] or tinidazole 500 mgs [OCT]. Eradication was confirmed by a repeat UBT. Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT [100%] had a significantly better eradication rate than OCM [87.8%], p = 0.023. There was no difference in side effects. [1] Positive Hp serology in patients with DU does not always mean active infection and [2] for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp

Impact of helicobacter pylori eradication on dyspeptic symptoms in the community

Eradication of Helicobacter pylori [Hp] will cure most Hp positive duodenal ulcers [DU]. However, after such treatment, patients often continue to get dyspeptic symptoms. The effects of Hp eradication in patients with proven DU on gastro-oesophageal reflux disease [GORD] symptoms are controversial. Aims: To study any changes in patient's symptoms following eradication of Hp in the setting of chronic DU and its effects on the need for continuing treatment for acid suppression. Eighty out of 85 patients [94%] from general practice with documented successfully eradicated Hp with a week long triple therapy regimen. Their symptoms and requirement for acid suppression treatment were studied at enrolment and after successful eradication of Hp for a median of 17 months. Eighty one% patients had improvement in ulcer-type symptoms. 21% developed new GORD symptoms. 68% discontinued long-term acid-suppression treatment. 79% requiring continued acid suppression therapy had new or continued GORD symptoms. Patients in the community with Hp positive DU disease after eradication, 81% patients got symptomatic improvement, two third discontinued their acid suppressing therapy but 21% developed new GORD symptoms. Among those who required continued acid suppression, 79% had GORD symptoms