Update on the role of H pylori infection in gastrointestinal disorders: PEPTIC ULCERS

6 Mar

H pylori infection

H pylori is accepted as the primary cause of non-NSAID-induced peptic ulcer disease, with an estimated prevalence of 95% in patients with duodenal ulcers and 84% in patients with gastric ulcers. Indeed, eradication of H pylori in patients with both duodenal and gastric ulcers facilitates ulcer healing, reduces the rate of ulcer recurrence and reduces the risk of peptic ulcer bleeding. However, evidence is limited regarding the role of H pylori eradication in improving the symptoms associated with peptic ulcers.

McColl and colleagues evaluated the effect of H pylori eradication on dyspeptic symptoms in 97 patients with active peptic ulcers. After a follow-up of one to three years, dyspeptic symptoms resolved in 55% of the 86 patients in whom H pylori had been successfully eradicated. No change in dyspeptic symptoms was observed in the 11 patients in whom eradication therapy was unsuccessful. Stratification of the 86 successfully eradicated patients for the presence of GERD before treatment demonstrated that dyspeptic symptoms resolved in significantly fewer patients who had GERD than patients who had no evidence of GERD (27% versus 68%, respectively; P<0.01). Therefore, it appears that eradication of H pylori assists in symptom resolution in patients with peptic ulcers but that symptom improvement is limited in patients with coexisting GERD. You can enjoy cheap drugs that work – to benefit the most from it.

The abundance of evidence for the relationship between the presence of H pylori and peptic ulcer disease is reflected in the current Canadian Consensus Guidelines, which recommend the eradication of H pylori in all patients with confirmed H pylori infection and past or current peptic ulcer. In Canada, seven days of twice-daily treatment with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole is currently recommended for the eradication of H pylori. Management strategies may change in the future because of the increase in the proportion of patients in the United States with non-NSAID-related ulcers who are not infected with H pylori, but Canadian data are necessary before a change is warranted.