ackground : The recurrence rate of duodenal ulcer (DU) within 12 month after treatment is 70∼90%. Since the identification of Helicobacter pylori (H. Pylori) which has been confirmed to be the major causal agent of chronic antral gastritis,
the
close linkage between
the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more
than 90% of patients with DU have stimulated studies on the use of anti-H.pylori
antimicrobial agents in DU. However, the definition of eradication related with the time at
which assessment is made after the completion of therapy has not been unified, and
moreover, there is no general agreement on how H. pylori should be eradicated.
Methods : This study was performed for 190 DU patients and four different
methods-culture, Gram stain of touch print, H&E stain, mucosal urease test- were taken for
H. pylori test just before treating to identify the infection rate of H. pylori in DU patients,
immediately after each 6 week ulcer therapy to assess the negative conversion rate of H.
Pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of
H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS),
CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy).
To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 month after therapy.
Results :
1) The infection rate of H. pylori in DU patients in Korea was 94.2%.
2) The negative conversion rate of H. Pylori immediately after the therapy in cimetidine
group was 0%, and that of omeprazole group was 16.7% but one half of the negative
converted cases was converted to be positive 4 weeks later after the comletion of therapy, so
the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in
all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In
double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients
persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1%, which
is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the
negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be
negative, so the eradication rate was 88.5%, which is higher than that of double therapy
group.
3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18
months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18
months later. In CBS group, that was 33.3% in 1 year and 44.4% in 18 months later. In
double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively.
In triple therapy group, that was both 3.8% in 1 year and 18 months later.
4) then all of these patients were classified into two groups according to the eradication of
H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that
was 57.1% (24 patients) in the 42 patients with H. pylori not eradicated.
Conclusion : From these results, we can conclude that in order to evaluate the eradication
of H.pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of
therapy than immediately after the therapy, and the eradication of H. Pylori in DU patients
reduces the recurrence of DU.
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