Symptomatic and endoscopic duodenal ulcer relapse rates 12 months following Helicobacter pylori eradication treatment with omeprazole and amoxycillin with or without metronidazole

Aim: To determine the effect of Helicobacter pylori eradication with omeprazole and amoxycillin, with or without metronidazole, on the 12-month course of duodenal ulcer disease. Methods: In a randomized, double-blind study, conducted in 19 hospitals, 105 H. pylori positive duodenal ulcer patients were healed and symptom-free following either omeprazole dual therapy (omeprazole 40 mg o.m.+amoxycillin 500 mg t.d.s., OA, eradication rate 46%, n=52) or omeprazole triple therapy (omeprazole 40 mg o.m.+amoxycillin 500 mg t.d.s.+metronidazole 400 mg t.d.s., OAM, eradication rate 92%, n=53) for 2 weeks, followed by 2 weeks of omeprazole 20 mg o.m. and a 12-month untreated follow-up period, after which time all patients were endoscoped. Endoscopic and symptomatic relapse rates, and effect on H. pylori status measured using ¹³C-urea breath test, were determined. Results: During the 12-month untreated follow-up period, the life-table endoscopic relapse rates were 12% (95% CI: 2–22%) and 2% (95% CI: 0–6%) for OA and OAM patients, respectively. By 12 months, life-table symptomatic relapse rates were 22% (95% CI: 13–37%) and 19% (95% CI: 8–30%) for OA and OAM, respectively. In the 12 months untreated follow-up period, 2/69 (3%, 95% CI: 0–7%) patients rendered H. pylori negative had an endoscopic relapse at the end of the 12-month follow-up period, compared with 5/31 (16%, 95% CI: 3–29%) patients remaining H. pylori positive (P=0.03 between H. pylori positive and negative groups). Twelve of 69 (17%, 95% CI: 8–26%) patients rendered H. pylori negative relapsed symptomatically, compared with 9/31 (29%, 95% CI: 13–45%) patients remaining H. pylori positive (P= N.S. between groups). There was a significant improvement in epigastric pain (P=0.0001), nausea and vomiting (P<0.05) between entry to the study and 1, 6 and 12 months post-treatment for both treatment groups. Conclusions: OAM eradicates H. pylori in significantly more patients than OA, but successful H. pylori eradication with either OAM or OA predisposes to low endoscopic and symptomatic relapse rates for duodenal ulcer patients when followed up for 12 months.     

A New Property of Iso-Agglutinins of the ABO Blood Group System

A new agglutination phenomenon in the ABO group system is described.This phenomenon consists of the development of agglutinates by interactionbetween a single specifically sensitized cell and other unsensitized, nonantigenic cells. Aggregates of cells formed in this way are tentatively describedas "anomalous mixed agglutinates."

Some of the properties of anomalous mixed agglutinates have been investigated, and the impact of these properties on the current theories ofagglutination is briefly discussed.

Submitted on November 21, 1958 Accepted on January 7, 1959     

Hereditary Persistence of Fetal Hemoglobin: A Study of 79 Affected Persons in 15 Negro Families in Baltimore

Hereditary persistence of fetal hemoglobin is an anomaly of hemoglobinproduction apparently caused by a mutant gene that inhibits synthesis ofhemoglobins A and A₂. Alkali-resistant hemoglobin indistinguishable fromhemoglobin F of umbilical cord blood is produced, presumably as a compensatory phenomenon, so that neither anemia nor hypochromia of the red cellsoccurs. The data summarized are compatible with the hypothesis that functionof the loci of the and chains of globin is wholly suppressed, quite possibly by a mutant "operator" gene affecting linked structural loci. Heterozygotesfor the anomaly have high concentrations of hemoglobin F in the erythrocytes,with a remarkably uniform distribution of fetal hemoglobin throughout thered cell population. Erythrocytes of persons with the anomaly resembleadult red cells with respect to the non-hemoglobin proteins and the oxygendissociation curve. Experience with 79 affected Negroes in Baltimore is compared with that reported by other investigators. The occasional difficulty indifferentiating the anomaly from other conditions, particularly thalassemia,is emphasized.

Submitted on July 23, 1962