Efectos de la erradicación de helicobacter pylori sobre el reflujo gastroesofágico patológico en pacientes con úlcera duodenal / Evolution of gastroesophageal reflux disease after eradication of helicobacter pylori in patients with duodenal ulcer

Background: Helicobacter pylori infection is not a risk factor for gastroesophageal reflux disease and it could even be a protector factor. Aim: To study the relationship between H pylori eradication and gastroesophageal reflux symptoms in patients with duodenal ulcer. Patients and methods: One hundred eleven patients with duodenal ulcer and treated for H pylori infection were studied. In 96 patients, H pylori was successfully eradicated and were evaluated every four months with endoscopy, during the first year. Thereafter, an annual clinical assessment was performed and endoscopy was repeated only if clinically indicated. Results: Patient were followed for a mean of 41 months (range 4 months to 6 years). Twelve patients (10.8 percent) had esophagitis at recruitment and in nine, H pylori was eradicated. The frecuency of gastroesophageal reflux symptoms or esophagitis in this group was similar to the rest of patients. During the first year, the frecuency of reflux symptoms ranged from 9 to 19 percent. The frecuency of esophagitis persisted at about 10 percent, although 81 percent of patients with esophagitis did not have it on recruitment. After the first year, the frecuency of reflux symptoms declined significantly to about 8 percent. Conclusions: In these patients with duodenal ulcer, gastroesophageal reflux disease had a variable evolution after H pylori eradication

Tratamiento de la infección por helicobacter pylori en pacientes con úlcera duodenal: estudio de costo beneficio / Treatment of helicobacter pylori infection in patients with duodenal ulcer: a cost benefit study

Background: Epidemiological differences suggest that treatments for H. pylori eradication should be locally validated. Aim: To perform a cost benefit study of different treatment options for H. pylori infection. Patients and methods: One hundred and sixty-seven patients with active duodenal ulcer and H. pylori infection who completed a 2-week treatment with one of the following regimens were included: famotidine plus amoxycillin plus metronidazole (FAM), omeprazole plus amoxycillin plus tinidazole (OAT) or lansoprazole plus clarithromycin plus amoxycillin in 3 (LAC1) or 2 (LAC2) daily doses. We compared efficacy, adverse effects and cost. Results: Eradication rate was 74.6, 72.9, 96.4 y 91.7 percent for FAM, OAT, LAC1 and LAC2 respectively (p<0.05). Direct cost ranged from US$ 50 for FAM to US$ 220 for LAC1. A decision analysis was carried out in a model including direct and indirect costs and considering retreatment with antibiotics after the first treatment failure and one-year treatment with H2-blockers in case of a second failure. FAM was selected as the most cost-effective option, with an estimated cost of about US$ 300 ñ 148 per patient. However, cost associated to LAC2 was very similar (US$ 320 ñ 58) and the lower standard deviation suggests less variation. Sensitivity analyses, considering reasonable fluctuation in parameters such as eradication rate, cost and follow-up period suggest that a regimen containing a proton pump inhibitor, clarithromycin and amoxycillin may be the most cost-effective treatment. Conclusions: These results should be confirmed in other settings, specially in ordinary clinical practice, far from clinical research