Does Helicobacter pylori eradication reduce the long-term requirements for acid suppressants in patients with a history of peptic ulcer disease in general practice? Results from a four-year longitudinal study

Abstract

Background: Acid suppressants, especially proton-pump inhibitors, are major contributors to the drug costs in primary care. Although Helicobacter pylori eradication reduces peptic ulcer relapse, some studies suggest that patients may remain symptomatic and continue to require acid-suppressant therapy.

Methods: We identified all patients taking long-term acid suppressants in a large primary health care clinic to determine the proportion who had peptic ulcer disease and to examine the effect of H. pylori eradication on their long-term requirement for acid suppressants.

Results: 126/394 patients taking long-term acid suppressants had a definite diagnosis of peptic ulcer. Of these 126 patients, 60 were considered appropriate for the study. At Stage 1 (May 1994), all patients were tested for H. pylori infection and positive patients (60/66) received eradication therapy with omeprazole 20 mg bd and amoxycillin (1 gm bd) or clarithromycin (500 mg tds) for 2 weeks. Six weeks later (Stage 2) patients, requirements for continued acid-suppressant treatment were determined and previously positive subjects retested using the 13C urea breath rest. This showed that 70% (42/60) had been successfully eradicated. One year later (Stage 3), 44% (18/41) of the patients successfully eradicated still required acid suppressants. The majority of these patients (11/18; 61%) continued to remain on acid-suppressant treatment at 4 years (Stage 4) (95% CI 38%, 83%).

Conclusions: We found that about 1/3 of all patients on long-term acid-suppressant therapy in General Practice had a confirmed diagnosis of peptic ulcer disease. Despite successful eradication treatment for H. pylori at the start of the study, about half of these patients still used acid suppressants after 1 year and 1/4 patients (11/41) in this group continued to remain on acid-suppressant treatment for another 3 years.