Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection

Abstract

Objectives: The aim of the present study was to compare the rates of peptic ulcer recurrence and of complications in a cohort of 190 patients, before and up to 4 yr after eradication of Helicobacter pylori infection.

Methods: 190 patients with recurrent and/or complicated H. pylori-positive peptic ulcer disease (duodenal ulcer, n = 124; gastric ulcer, n = 59; gastroduodenal double ulcer, n = 2; anastomotic ulcer after partial gastric resection, n = 5) were prospectively followed up to 4 yr after eradication of H. pylori. Patients were investigated clinically and endoscopically, including the assessment of H. pylori infection before treatment, 4 wk after cessation of the eradication therapy, in 1-yr intervals and when symptoms of the ulcer disease recurred.

Results: Cure of H. pylori infection was obtained by either omeprazole plus amoxicillin (n = 157) or oral triple therapy (n = 33). The overall ulcer relapse rate was 0.9% per patient year. Comparing the pre- and postherapeutical course of the disease, the 1-yr ulcer recurrence rate decreased from 67.9% to 1.1% (P < 0.0001), and the 2-yr relapse rate decreased from 91.1% to approximately 3.0% (calculation: 0.9% ulcer recurrences per patient year x 329 patient years) (P < 0.0001) without relevant differences between the two major groups of patients with either duodenal or gastric manifestation of their ulcer disease. Ulcer complications did not occur. The H. pylori recurrence rate was 2.6% in the 1st and 1.2% in the 2nd yr after eradication. In the 3rd and 4th yr, no H. pylori reinfections were detected.

Conclusion: Cure of H. pylori infection was associated with a highly significant change of the disease history in this large group of patients with formerly relapsing and/or complicated peptic ulcers. In addition, H. pylori eradication is a stable phenomenon at least during the first 4 yr after treatment. Thus, H. pylori eradication should be considered in those patients with peptic ulcer disease severe enough to require avoidance of ulcer recurrence or its complications.