Strategies for peptic ulcer healing after 1 week proton pump inhibitor-based triple Helicobacter pylori eradication therapy in Japanese patients: differences of gastric ulcers and duodenal ulcers

Abstract

Helicobacter pylori (H. pylori) eradication therapy alone is insufficient to ensure healing of large ulcers with H. pylori-positive gastric ulcer (GU). The question of what is the optimum antiulcer treatment following H. pylori eradication therapy has not been fully elucidated. Furthermore, the ulcer healing effects of eradication therapy itself with H. pylori-positive duodenal ulcer (DU) have not been investigated. In GU study, the eradication therapy + proton pump inhibitor (PPI) group (group A) were administered eradication therapy followed by 7 weeks of a PPI, and the eradication therapy + gastroprotective drug (GP) group (group B) eradication therapy followed by 7 weeks of a GP. In DU study, the eradication therapy + PPI group (group C) were administered eradication therapy followed by 5 weeks of a PPI, and the eradication therapy only group (group D) was eradication therapy alone. In GU study, healing rates for ulcer of ≥15 mm in diameter were significant greater in the group A. In DU study, high healing rates were seen both the group C and D. In conclusion, a PPI could significantly heal GU than a GP after eradication therapy in GU. Meanwhile, the eradication alone is sufficient for DU.

Keywords: Helicobacter pylori eradication therapy; gastroprotective drug; peptic ulcer; proton pump inhibitor; ulcer healing.

Fig. 1

Protocol for gastric ulcer arm. Subjects with GU were randomly allocated to an eradication therapy + PPI group, administered eradication therapy commencing the day after EGD, followed by 7 weeks of a PPI, or an eradication therapy + GP group, administered eradication therapy followed by 7 weeks of a GP.

Fig. 2

Protocol for duodenal ulcer arm. Subjects with DU were randomly allocated to an eradication therapy + PPI group, administered eradication therapy commencing the day after EGD, followed by 5 weeks of a PPI, or an eradication therapy only group administered eradication therapy alone.

Fig. 3

Study outline. We enrolled 115 H. pylori positive patients with GU. The eradication therapy + PPI group comprised 60 subjects, and the eradication therapy + GP group 55. We enrolled 78 H. pylori positive patients with DU. The eradication therapy + PPI group comprised 40 subjects, and the eradication therapy only group 38.