The impact of Helicobacter pylori eradication on peptic ulcer healing |
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Authors: | G Treiber MD JR Lambert MD |
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Institution: | Departments of Gastroenterology, Robert-Bosch Hospital, Stuttgart, Germany;PPD Pharmaco, Cambridge, United Kingdom |
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Abstract: | Objective: Current literature was reviewed analyzing the outcome of peptic ulcer healing in relation to the results of the posttherapeutic Helicobacter pylori (HP) status. Methods: Literature was reviewed along with an analysis of 60 studies, comprising a total of 4329 patients. Results: Successful Helicobacter pylori eradication was found to induce a better response in peptic ulcer healing, regardless of diagnosis: gastric ulcer 88% vs 73% (odds ratio OR] 2.7, p < 0.01 ), duodenal ulcer 95% vs 76% (OR 5.6, p < 0.0001 ), and peptic ulcer 95% vs 76% (OR 6.6, p < 0.0001 ), for patients having their HP infection successfully cured versus those remaining HP-positive, respectively (Fisher's exact test). For all evaluated time points (≤ 6, 7–8, and 10–12 wk after beginning treatment), HP-negative patients had higher healing rates than HP-positive patients (95% vs 82%, 94% vs 69%, and 96% vs 78% with corresponding OR of 4.2, 6.5, and 7.4, all p < 0.0001 , Fisher's exact test). The use of concomitant acid suppression therapy during initial HP eradication provided a benefit on peptic ulcer healing only for patients with persistent HP infection (improved healing rates of 78% vs 67%; otherwise rates were 94–96%). Likewise, prolonged acid inhibition in HP treatment failures after the initial HP treatment phase resulted in 7–20% improved healing rates, whereas patients becoming HP-negative did not profit. Conclusion: Successful HP eradication therapy accelerates peptic ulcer healing even without concomitant acid suppression. |
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