-3-fatty acids which have been shown to have anti-H. pylori bacteriostatic effects. However, replacing metronidazole with eicosapen is ineffective [439]. C5
Pronase, a mucolytic agent with no antibacterial effect on H. pylori, added to lansoprazole, amoxicillin and metronidazole significantly improved eradication success to 94% compared with 77% (p = 0.004) observed with the LAM triple therapy alone [440]. A1d Regimens adding pronase deserve further study.
Lactoferrin is a multifunctional protein found in milk and when added to standard esomeprazole, clarithromycin and amoxicillin triple therapy it did not improve the eradication rate [441]. In an Italian study, lactoferrin significantly reduced the rate of adverse effects from 29.41% 17.64% (p < 0.05) [442]. When used with rabeprazole, clarithromycin and tinidazole, the addition of lactoferin resulted in an eradication rate of 72%, not significantly different from the rate of 68% observed with the alternative triple therapy regimen containing rabeprazole, levofloxacin and amoxycillin [443]. A1d
Summary
H. pylori remains an important cause of ulcer disease, with acceptance as a definite pathogen that fulfills almost all of Hill’s criteria for causation. In the new millennium, ulcers not caused by H. pylori or non-steroidal anti-inflammatory drugs appear to be on the increase. The older data from the pre-H. pylori era has become important again as in these patients there may be little else to offer for ulcer healing and prevention of recurrence other than continuous acid-suppressive therapy. For those with H. pylori infection, eradication remains important to facilitate ulcer healing, reduce ulcer relapse and prevent complications such as recurrent hemorrhage. Eradication of H. pylori heals ulcers without the need to continue ulcer healing drugs, heals refractory ulcers and also results in faster ulcer healing than occurs with traditional acid-suppressive therapy.
The present recommended first-line therapies include triple therapy with either PPI or RBC with clarithromycin and amoxicillin or metronidazole or a quadruple therapy with a PPI, bismuth compound, metronidazole and tetra-cycline (Table 6.3). First-line therapy should be administered for 7–10 days and for treatment failures, 10–14 days of treatment is recommended.
With emerging antimicrobial resistance, first-line therapies may not be quite as effective as in the recent past. There is evidence to support the use of a number of regimens for these eradication failures (see Table 6.3).
References
1 Schwarz K. Uber penetrierende Magen- und Jejunalgeschwure. Beiträge Zur Klinische Chirurgie 1910; 67: 96–128.
2 Warren JR, Marshall BJ. Unidentified curved bacillus on gastric epithelium in active chronic gastritis. Lancet 1983; 1: 1273–1275.
3 Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1(16 June): 1311–1315.
4 Mégraud F, Lamouliatte H. Helicobacter pylori and duodenal ulcer. Evidence suggesting causation. Dig Dis Sci 1992; 37: 769–772.
5 Rabeneck L, Ransohoff DF. Is Helicobacter pylori a cause of duodenal ulcer? A methodologic critique of current evidence. Am J Med 1991; 91: 566–572.
6 Hill BA. The environment and disease: Association or causation? Proc R Soc Med 1965; 58: 295–300.
7 Nomura A, Stemmerman GN, Chyou P-H, Perez-Perez GI, Blaser MJ. Helicobacter pylori infection and the risk for duodenal and gastric ulceration. Annals of Internal Med 1994; 120: 977–981.
8 Sipponen P, Varis K, Fraki O, Korri UM, Seppala K, Siurala M. Cumulative 10-year risk of symptomatic duodenal and gastric ulcer disease in people with or without chronic gastritis: A clinical follow-up study of 454 outpatients. Scand J Gastroenterol 1990; 25: 966–973.
9 Kuipers EJ, Thijs JC, Festen HPM. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther 1995; 9(Suppl 2): 59–69.
10 Borody TJ, George LL, Brandl S, et al. Helicobacter pylori negative duodenal ulcer. Am J Gastroenterol 1991; 86: 1154–1157.
11 Talamini G, Tommasi M, Amadei V et al. Risk factors of peptic ulcer in 4943 inpatients. J Clin Gastroenterol 2008; 42: 373–380.
12 Nervi G, Liatopoulou S, Cavallaro LG et al. Does Helicobacter pylori infection eradication modify peptic ulcer prevalence? A 10 years’ endoscopical survey. World J Gastroenterol 2006; 12: 2398–2401.
13 Jang HJ, Choi MH, Shin WG et al. Has peptic ulcer disease changed during the past ten years in Korea? A prospective multi-center study. Dig Dis Sci 2008; 53: 1527–1531.
14 Xia B, Xia HH, Ma CW et al. Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician-referred uninvestigated dyspeptic patients in Hong Kong. Aliment Pharmacol Ther 2005; 22: 243–249.
15 Quan C, Talley NJ. Management of peptic ulcer disease not related to Helicobacter pylori or NSAIDs. Am J Gastroenterol 2002; 97: 2950–2961.
16 Laine L, Hopkins RJ, Girardi LS. Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta- analysis of rigorously designed trials. Am J Gastroenterol 1998; 93: 1409–1415.
17 Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999; 94: 1834–1840.
18 Cloud ML, Enas N, Humphries TJ, Bassion S. Rabeprazole in treatment of acid peptic diseases: Results of three placebo-controlled dose-response clinical trials in duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease (GERD). The Rabeprazole Study Group. Dig Dis Sci 1998; 43: 993–1000.
19 Yakoob J, Jafri W, Jafri N, Islam M, Abid S, Hamid S, AliShah H, Shaikh H. Prevalence of non-Helicobacter pylori duodenal ulcer in Karachi, Pakistan. World J Gastroenterol 2005; 11: 3562–3565.
20 Gisbert JP, Blanco M, Mateos JM et al. pylori-negative duodenal ulcer prevalence and causes in 774 patients. Dig Dis Sci 1999; 44: 2295–2302.
21 Rosenstock S, Jorgensen T, Bonnevie O, Andersen L. Risk factors for peptic ulcer disease: A population based prospective cohort study comprising 2416 Danish adults. Gut 2003; 52: 186–193.
22 Ong TZ, Hawkey CJ, Ho KY. Nonsteroidal anti-inflammatory drug use is a significant cause of peptic ulcer disease in a tertiary hospital in Singapore: A prospective study. J Clin Gastroenterol 2006; 40: 795–800.
23 Aro P, Storskrubb T, Ronkainen J et al. Peptic ulcer disease in a general adult population: The Kalixanda study: A random population-based study. Am J Epidemiol 2006; 163: 1025–1034.
24 Arroyo MT, Forne M, de Argila CM et al. The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern Europe. Helicobacter 2004; 9: 249–254.
25 Arkkila PE, Seppala K, Kosunen Tu et al. Helicobacter pylori eradication as the sole treatment for gastric and duodenal ulcers. Eur J Gastroenterol Hepatol 2005; 17: 93–101.
26 Nishikawa K, Sugiyama T, Kato M et al. Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population. Eur J Gastroenterol Hepatol 2000; 12: 635–640.
27 Miwa H, Sakaki N, Sugano K et al. Recurrent peptic ulcers in patients following successful Helicobacter pylori eradication: A multicenter study of 4940 patients. Helicobacter 2004; 9: 9–16.
28 Hyvärinen H, Salmenkylä S, Sipponen P. Helicobacter pylori-negative duodenal and pyloric ulcer: Role of NSAIDs. Digestion 1996; 57: 305–309.
29 Harris AW, Gummett PA, Phull PS, Jacyna MR, Misiewicz JJ, Baron JH. Recurrence of duodenal ulcer after Helicobacter pylori eradication is related to high acid output. Aliment Pharmacol Ther 1997; 11: 331–334.
30 McColl KEL, El-Nujumi AM, Chittajallu RS et al. A study of the pathogenesis of Helicobacter pylori negative chronic duodenal ulceration. Gut 1993; 34: 762–768.
31 Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol 1997; 24: 2–17.
32 Choung RS, Talley NJ. Epidemiology and clinical presentation of stress-related peptic damage and chronic peptic ulcer. Curr Mol Med 2008; 8: 253–257.
33 Chen TS, Chang FY Clinical characteristics of Helicobacter pylori-negative duodenal ulcer disease. Hepatogastroenterology 2008; 55: 1615–1618.
34 Rosenstock SJ, Jorgensen T, Bonnevie O, Andersen LP. Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults. Scand J Gastroenterol 2004; 39: 823–829.
35 Ohara T, Morishita T, Suzuki H, Masaoka T, Ishii H. Usefulness of proton pump inhibitor (PPI) maintenance therapy for patients with H. pylori-negative recurrent peptic ulcer after eradication therapy for H. pylori: pathophysiological characteristics of H. pylori-negative recurrent ulcer scars and beyond acid suppression by PPI. Hepatogastroenterology 2004; 51: 338–342.
36 Thijs JC, Kuipers EJ, van Zwet AA, Pena AS, de Graaff J. Treatment of Helicobacter pylori infections. QJM 1995; 88: 369–389.
37 Borody TJ, Brandl S, Andrews P, Jankiewicz E, Ostapowicz N. Helicobacter pylori negative gastric ulcer. Am J Gastroenterol 1992; 87: 1403–1406.
38 Rauws EAJ, Langenberg W, Houthoff HJ, Zanen HC, Tytgat GNJ. Campylobacter pyloridis-associated chronic active antral gastritis. Gastroenterology 1988; 94: 33–40.
39 Graham DY, Malaty HM. Alendronate gastric ulcers. Aliment Pharmacol Ther 1999; 13: 515–519.
40 Thomson AB, Marshall JK, Hunt RH et al. 14 day endoscopy study comparing risedronate and alendronate in postmenopausal women stratified by Helicobacter pylori status. J Rheumatol 2002; 29: 1965–1974.
41 Graham DY, Malaty HM. Alendronate and naproxen are synergistic for development of gastric ulcers. Arch Intern Med 2001; 161: 107–110.
42 Walsh JH, Peterson WL. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med 1995; 333: 984–991.
43 Jyotheeswaran S, Shah AN, Jin HO, Potter GD, Ona FV, Chey WY. Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: Is empirical triple therapy justified? Am J Gastroenterol 1998; 93: 574–578.
44 Marshall BJ. Helicobacter pylori in peptic ulcer: Have Koch’s postulates been fulfilled? Ann Med 1995; 27: 565–568.
45 Blaser MJ, Chyou P-H, Nomura A. Age at establishment of Helicobacter pylori infection and gastric carcinoma, gstric ulcer, and duodenal ulcer risk. Cancer Research 1995; 55: 562–565.
46 Perri F, Clemente R, Pastore M et al. The 13C-urea breath test as a predictor of intragastric bacterial load and severity of Helicobacter pylori gastritis. Scand J Clin Lab Invest 1998; 58: 19–27.
47 Labenz J, Börsch G, Peitz U, Aygen S, Hennemann O, Tillenburg B, Becker T, Stolte M. Validity of a novel biopsy urease test (HUT) and a simplified 13C-urea breath test for diagnosis of Helicobacter pylori infection and estimation of the severity of gastritis. Digestion 1996; 57: 391–397.
48 Hilker E, Domschke W, Stoll R. 13C-urea breath test for detection of Helicobacter pylori and its correlation with endoscopic and histologic findings. J Physiol Pharmacol 1996; 47: 79–90.
49 Moshkowitz M, Konikoff FM, Peled Y et al. High Helicobacter pylori numbers are associated with low eradication rate after triple therapy. Gut 1995; 36: 845–847.
50 Sharma TK, Prasad VM, Cutler AF. Quantitative noninvasive testing for Helicobacter pylori does not predict gastroduodenal ulcer disease. Gastrointest Endosc 1996; 44: 679–682.
51 Lewis JD, Kroser J, Bevan J, Furth EE, Metz DC. Urease-based tests for Helicobacter pylori gastritis. Accurate for diagnosis but poor correlation with disease severity. J Clin Gastroenterol 1997; 25: 415–420.
52 Moran AP, Wadström T. Pathogenesis of Helicobacter pylori. Curr Opin Gastroenterol 1998; 14(Suppl 1): S9–S14.
53 Arachchi HS, Kalra V, Lal B et al. Prevalence of duodenal ulcer-promoting gene (dupA) of Helicobacter pylori in patients with duodenal ulcer in North Indian population. Helicobacter 2007; 12: 591–597.
54 Argent RH, Burette A, Miendje Deyi VY, Atherton JC. The presence of dupA in Helicobacter pylori is not significantly associated with duodenal ulceration in Belgium, South Africa, China, or North America. Clin Infect Dis 2007; 45: 1204–1206.
55 Yang H, Dixon MF, Zuo J, Fong F, Zhou D, Corthésy I, Blum A. Helicobacter pylori infection and gastric metaplasia in the duodenum in China. J Clin Gastroenterol 1995; 20: 110–112.
56 Harris AW, Gummett PA, Walker MM, Misiewicz JJ, Baron JH. Relation between gastric acid output, Helicobacter pylori, and gastric metaplasia in the duodenal bulb. Gut 1996; 39: 513–520.
57 Walker MM, Dixon MF. Gastric metaplasia: Its role in duodenal ulceration. Aliment Pharmacol Ther 1996; 10 Suppl 1: 119–128.
58 Madsen JE, Vetvik K, Aase S. Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients. APMIS 1991; 99: 997–1000.
59 Steer HW. Surface morphology of the gastroduodenal mucosa in duodenal ulceration. Gut 1984; 25: 1203–1210.
60 Carrick J, Lee A, Hazell S, Ralston M, Daskalopoulos G. Campylobacter pylori, duodenal ulcer, and gastric metaplasia: Possible role of functional heterotopic tissue in ulcerogenesis. Gut 1989; 30: 790–797.
61 Khulusi S, Mendall MA, Badve S, Patel P, Finlayson C, Northfield TC. Effect of Helicobacter pylori eradication on gastric metaplasia of the duodenum. Gut 1995; 36: 193–197.
62 Rudnicka L, Bobrzynski A, Stachura J. Short-term eradication therapy for Helicobacter pylori does not reduce the incidence of gastric metaplasia in duodenal ulcer patients. Pol J Pathol 1997; 48: 103–106.
63 Khulusi S, Badve S, Patel P et al. Pathogenesis of gastric metaplasia of the human duodenum: role of Helicobacter pylori, gastric acid, and ulceration. Gastroenterology 1996; 110: 452–458.
64 Urakami Y, Kimura M, Seki H. Gastric metaplasia and Helicobacter pylori. Am J Gastroenterol 1997; 92: 795–799.
65 el-Omar E, Penman I, Dorrian CA, Ardill JE, McColl KE. Eradicating Helicobacter pylori infection lowers gastrin mediated acid secretion by two thirds in patients with duodenal ulcer. Gut 1993; 34: 1060–1065.
66 Gillen D, el-Omar EM, Wirz AA, Ardill JES, McColl KEL. The acid response to gastrin distinguishes duodenal ulcer patients from Helicobacter pylori-infected healthy subjects. Gastroenterol 1998; 114: 50–57.
67 Graham DY, Opekun A, Lew GM, Klein PD, Walsh JH. Helicobacter pylori-associated exaggerated gastrin release in duodenal ulcer patients. The effect of bombesin infusion and urea ingestion. Gastroenterol 1991; 100: 1571–1575.
68 Hamlet A, Olbe L. The influence of Helicobacter pylori infection on postprandial duodenal acid load and duodenal bulb pH in humans. Gastroenterol 1996; 111: 391–400.
69 el Omar EM, Penman ID, Ardill JE, Chittajallu RS, Howie C, McColl KE. Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease. Gastroenterology 1995; 109: 681–691.
70 Harris AW, Gummett PA, Misiewicz JJ, Baron JH. Eradication of Helicobacter pylori in patients with duodenal ulcers lowers basal and peak acid outputs in response to gastrin releasing peptide and pentagastrin. Gut 1996; 38: 663–667.
71 Beardshall K, Moss S, Gill J, Levi S, Ghosh P, Playford RJ, Calam J. Suppression of Helicobacter pylori reduces gastrin releasing peptide stimulated gastrin release in duodenal ulcer patients. Gut 1992; 33: 601–603.
72 Harris AW, Gummett PA, Phull PS, Jacyna MR, Misiewicz JJ, Baron JH. Recurrence of duodenal ulcer after Helicobacter pylori eradication is related to high acid output. Aliment Pharmacol Ther 1997; 11: 331–334.
73 Rieder G, Hatz RA, Moran AP, Walz A, Stolte M, Enders G. Role of adherence in interleukin-8 induction induction in Helicobacter pylori-associated gastritis. Infect Immun 1997; 65: 3622–3630.
74 Yamaoka Y, Kita M, Kodama T, Sawi N, Kashima K, Imanishi J. Induction of various cytokines and development of severe mucosal inflammation by cagA gene positive Helicobacter pylori strains. Gut 1997; 41: 442–451.
75 D’Elios MM, Manghetti M, Almerigogna F, Amedei A, Costa F, Burroni D, et al. Different cytokine profile and antigen-specificity repertoire in Helicobacter pylori-specific T cell clones from the antrum of chronic gastritis patients with or without peptic ulcer. EurJImmunol 1997; 27: 1751–1755.
76 Beales I, Blaser MJ, Srinivasan S et al. Effect of Helicobacter pylori products and recombinant cytokines on gastrin release fromcultured canine G cells. Gastroenterol 1997; 113: 465–471.
77 Londong W, Barth H, Dammann HG et al. Dose-related healing of duodenal ulcer with the proton pump inhibitor lansoprazole. Aliment Pharmacol Ther 1991; 5: 245–254.
78 Bardhan KD, Bianchi Porro G, Bose K et al. A comparison of two different doses of omeprazole versus ranitidine in treatment of duodenal ulcers. J Clin Gastroenterol 1986; 8: 408–413.
79 Misra SC, Dasarathy S, Sharma MP. Omeprazole versus famotidine in the healing and relapse of duodenal ulcer. Aliment Pharmacol Ther 1993; 7: 443–449.
80 Dammann HG, Walter TA. Efficacy of continuous therapy for peptic ulcer in controlled clinical trials. Aliment Pharmacol Ther 1993; 7(Suppl 2): 17–25.
81 Penston JG, Wormsley KG. Nine years of maintenance treatment with ranitidine for patients with duodenal ulcer disease. Aliment Pharmacol Ther 1992; 6: 629–645.
82 O’Brien BJ, Goeree R, Hunt R, Wilkinson J, Levine M, Willan A. Economic Evaluation of Alternative Therapies in the Long Term Management of Peptic Ulcer Disease and Gastroesophageal Reflux Disease. Report to CCOHTA 1996; RFP no.9503-OMEP: 1–130. McMaster University: 1996.
83 Veldhuyzen van Zanten SJO, Bradette M, Farley A et al. The DU-MACH study: Eradication of Helicobacter pylori and ulcer healing in patients with acute duodenal ulcer using omeprazole based triple therapy. Aliment Pharmacol Ther 1999; 13: 289–295.
84 Coghlan JG, Humphries H, Dooley C, et al. Campylobacter pylori and recurrence of duodenal ulcer – a 12 month follow up study. Lancet 1987; 2: 1109–1111.
85 Marshall BJ, Goodwin CS, Warren JR et al. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet 1988; ii: 1437–1442.
86 Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet 1990; 335: 1233–1235.
87 George LL, Borody TJ, Andrews P, Devine M, Moore-Jones D, Walton M, Brandl S. Cure of duodenal ulcer after eradication of Helicobacter pylori. Med J Aust 1990; 153: 145–149.
88 Graham DY, Lem GM, Evans DG, Evans DJ, Jr, Klein PD. Effect of triple therapy (antibiotics plus bismuth) on duodenal ulcer healing. A randomized controlled trial. Ann Intern Med 1991; 115: 266–269.
89 Graham DY, Lew GM, Klein PD et al. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study. Ann Intern Med 1992; 116: 705–708.
90 Hentschel E, Brandstatter G, Dragosics B et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med 1993; 328: 308–312.
91 Tytgat GNJ. Review article: treatments that impact favourably upon the eradication of Helicobacter pylori and ulcer recurrence. Aliment Pharmacol Ther 1994; 8: 359–368.
92 Penston JG. Helicobacter pylori eradication – understandable caution but no excuse for inertia. Aliment Pharmacol Ther 1994; 8: 369–389.
93 Labenz J, Börsch G. Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection. Am J Gastroenterol 1994; 89: 1785–1788.
94 Forbes GM, Glaser ME, Cullen DJE, Warren JR, Christiansen KJ, Marshall BJ, Collins BJ. Duodenal ulcer treated with Helicobacter pylori eradication: Seven year follow-up. Lancet 1994; 343: 258–260.
95 Hopkins RJ, Girardi LS, Turney EA. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: A review. Gastroenterology 1997; 110: 1244–1252.
96 Leodolter A, Kulig M, Brasch H, Meyer-Sabellek W, Willich SN, Malfertheiner P. A meta-analysis comparing eradication, healing and relapse rates in patients with Helicobacter pylori-associated gastric or duodenal ulcer. Aliment Pharmacol Ther 2001; 15: 1949–1958.
97 Susser M. Civilization and peptic ulcer. Lancet 1962; 1: 115–119.
98 Svanes C, Lie RT, Kvåle G, Svanes K, Søreide O. Incidence of perforated ulcer in Western Norway 1935–1990: Cohort or period dependent time trends? Am J Epidemiol 1995; 141: 836–844.
99 Banatvala N, Mayo K, Mégraud F, Jennings R, Deeks JJ, Feldman RA. The cohort effect and Helicobacter pylori. J Infect Dis 1993; 168: 219–221.
100 Coggon D, Lambert P, Langman MJS. 20 years of hospital admissions for peptic ulcer in England and Wales. Lancet 1981; 1: 1302–1304.
101 Manuel D, Cutler A, Goldstein J, Fennerty MB, Brown K. Decreasing prevalence combined with increasing eradication of Helicobacter pylori infection in the United States has not resulted in fewer hospital admissions for peptic ulcer disease-related complications. Aliment Pharmacol Ther 2007; 25: 1423–1427.
102 Kurata JH. Ulcer epidemiology: An overview and proposed research framework. Gastroenterology 1989; 96: 569–580.
103 Mégraud F, Brassens-Rabbé MP, Denis F, Belbouri A, Hoa DQ. Seroepidemiology of Campylobacter pylori in various populations. J Clin Microbiol 1989; 27: 1870–1873.
104 Jones DB, Howden CW, Burget DW, Kerr GD, Hunt RH. Acid suppression in duodenal ulcer: A meta-analysis to define optimal dosing with antisecretory drugs. Gut 1987; 28: 1120–1127.
105 Burget DW, Chiverton SG, Hunt RH. Is there an optimal degree of acid suppression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression. Gastroenterology 1990; 99: 345–351.
106 Wilairatana S, Kurathong S, Atthapaisalsarudee C, Saowaros V, Leethochawalit M. Omeprazole or cimetidine once daily for the treatment of duodenal ulcers? J Gastroenterol Hepatol 1989; 4: 45–52.
107 Archambault AP, Pare P, Bailey RJ et al. Omeprazole (20 mg daily) versus cimetidine (1200 mg daily) in duodenal ulcer healing and pain relief. Gastroenterol 1988; 94: 1130–1134.
108 Hawkey CJ, Long RG, Bardhan KD et al. Improved symptom relief and duodenal ulcer healing with lansoprazole, a new proton pump inhibitor, compared with ranitidine. Gut 1993; 34: 1458–1462.
109 Judmaier G, Koelz HR, & Pantopazole-duodenal ulcer-study group. Comparison of pantoprazole and ranitidine in the treatment of acute duodenal ulcer. Aliment Pharmacol Ther 1994; 8: 81–86.
110 McFarland RJ, Bateson MC, Green JRB, O’Donogue DP, Dronfield MW. Omeprazole provides quicker symptom relief and duodenal ulcer healing than ranitidine. Gastroenterology 1990; 98: 278–283.
111 van Rensburg CJ, van Eeden PJ, Marks IN et al. Improved duodenal ulcer healing with pantoprazole compared with ranitidine: A multicentre study. Eur J Gastroenterol Hepatol 1994; 6: 739–743.
112 Chiba N. (2004) Ulcer disease and Helicobacter pylori. In: McDonald JWD, Burroughs AK and Feagan BG, eds. Evidence- based Gastroenterology and Hepatology. 2nd ed. Blackwell Publishing Ltd, New Delhi, 2004: 83–116.
113 Arber N, Avni Y, Eliakim R, Swissa A, Melzer E, Rachmilewitz D, Konikoff F. A multicenter, double-blind, randomized controlled study of omeprazole versus ranitidine in the treatment of duodenal ulcer in Israel. Isr J Med Sci 1994; 30: 757–761.
114 Barbara L, Blasi A, Cheli R et al. Omeprazole vs. ranitidine in the short-term treatment of duodenal ulcer: an Italian Multicenter study. Hepato-gastroenterol 1987; 34: 229–232.
115 Classen M, Dammann HG, Domschke W et al. Omeprazole heals duodenal, but not gastric ulcers more rapidly than ranitidine. Results of two German multicentre trials. Hepato- gastroenterol 1985; 32: 243–245.
116 Cremer M, Lambert R, Lamers CBHW, Delle Fave G, Maier C, and the European Pantoprazole study group. A double-blind study of pantoprazole and ranitidine in treatment of acute duodenal ulcer. A multicentre study. Dig Dis Sci 1995; 40: 1360–1364.
117 Crowe JP, Wilkinson SP, Bate CM, Willoughby CP, Peers EM, Richardson PDI, & the OPUS (Omeprazole Peptic Ulcer Study) Research Group. Symptom relief and duodenal ulcer healing with omeprazole or cimetidine. Aliment Pharmacol Ther 1989; 3: 83–91.
118 Hui WM, Lam SK, Lau WY et al. Omeprazole and ranitidine in duodenal ulcer healing and subsequent relapse: A randomized double-blind study with weekly endoscopic assessment. J Gastroenterol Hepatol 1989; 4: 35–43.
119 Hotz J, Kleiner R, Grymbowski T, Hennig U, Schwarz JA. Lansoprazole versus famotidine: efficacy and tolerance in the acute management of duodenal ulceration. Aliment Pharmacol Ther 1992; 6: 87–95.
120 Lanza F, Goff J, Scowcroft C, Jennings D, Greski RP. Double-blind comparison of lansoprazole, ranitidine, and placebo in the treatment of acute duodenal ulcer. Lansoprazole Study Group. Am J Gastroenterol 1994; 89: 1191–1200.
121 Mulder CJJ, Tijtgat GNJ, Cluysenaer OJJ et al. Omeprazole (20mg o.m.) versus ranitidine (150mg b.d.) in duodenal ulcer healing and pain relief. Aliment Pharmacol Ther 1989; 3: 445–451.
122 Schepp W, Classen M. Pantoprazole and ranitidine in the treatment of acute duodenal ulce. A multicentre study. Scand J Gastroenterol 1995; 30: 511–514.
123 Wang CY, Wang TH, Lai KH et al. Alimentary tract and pancreas. Double-blind comparison of omeprazole 20 mg OM and ranitidine 300 mg NOCTE in duodenal ulcer: A Taiwan multi-centre study. J Gastroenterol Hepatol 1992; 7: 572–576.
124 Valenzuela JE, Berlin RG, Snape WJ et al. U.S. experience with omeprazole in duodenal ulcer. Multicenter double-blind comparative study with ranitidine. Dig Dis Sci 1991; 36: 761–768.
125 Ekstrom P, Carling L, Unge P, Anker-Hansen O, Sjostedt S, Sellstrom H. Lansoprazole versus omeprazole in active duodenal ulcer. A double-blind, randomized, comparative study. Scand J Gastroenterol 1995; 30: 210–215.
126 Dobrilla G, Piazzi L, Fiocca R. Lansoprazole versus omeprazole for duodenal ulcer healing and prevention of relapse: A randomized, multicenter, double-masked trial. Clin Ther 1999; 21: 1321–1332.
127 Rehner M, Rohner HG, Schepp W Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration – a multicentre study. Aliment Pharmacol Ther 1995; 9: 411–416.
128 Dekkers CP, Beker JA, Thjodleifsson B, Gabryelewicz A, Bell NE, Humphries TJ. Comparison of rabeprazole 20mg versus omeprazole 20 mg in the treatment of active duodenal ulcer: A European multicentre study. Aliment Pharmacol Ther 1999; 13: 179–186.
129 Meneghelli UG, Zaterka S, de Paula CL, Malafaia O, Lyra LG. Pantoprazole versus ranitidine in the treatment of duodenal ulcer: A multicenter study in Brazil. Am J Gastroenterol 2000; 95: 62–66.
130 Breiter JR, Riff D, Humphries TJ. Rabeprazole is superior to ranitidine in the management of active duodenal ulcer disease: results of a double-blind, randomized North American study. Am J Gastroenterol 2000; 95: 936–942.
131 Ekstrom P, Carling L, Unge P, Anker-Hansen O, Sjostedt S, Sellstrom H. Lansoprazole versus omeprazole in active duodenal ulcer. A double-blind, randomized, comparative study. Scand J Gastroenterol 1995; 30: 210–215.
132 Beker J, Bianchi Porro G, Bigard M et al. Double-blind comparison of pantoprazole and omeprazole for the treatment of acute duodenal ulcer. Eur J Gastroenterol Hepatol 1995; 7: 407–410.
133 Ruszniewski Ph, Slama A, Pappo M, Mignon M, GEMUD. Two year maintenance treatment of duodenal ulcer disease with ranitidine 150 mg: a prospective multicentre randomised study. Gut 1993; 34: 1662–1665.
134 Palmer RH, Frank WO, Karlstadt R. Maintenance therapy of duodenal ulcer with H2-receptor antagonists – a meta-analysis. Aliment Pharmacol Ther 1990; 4: 283–294.
135 Kurata JH, Koch GG, Nogawa AN. Comparison of ranitidine and cimetidine ulcer maintenace therapy. J Clin Gastroenterol 1987; 9: 644–650.
136 Penston JG, Wormsley KG. Review article: maintenance treatment with H2-receptor antagonists for peptic ulcer disease. Aliment Pharmacol Ther 1992; 6: 3–29.
137 Lee FI, Hardman M, Jaderberg ME. Maintenance treatment of duodenal ulceration: ranitidine 300 mg at night is better than 150mg in cigarette smokers. Gut 1991; 32: 151–153.
138 Chiba N, Rao BV, Rademaker JW, Hunt RH. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol 1992; 87: 1716–1727.
139 Kovacs TO, Campbell D, Richter J, Haber M, Jennings DE, Rose P. Double-blind comparison of lansoprazole 15 mg, lansoprazole 30mg and placebo as maintenance therapy in patients with healed duodenal ulcers resistant to H2-receptor antagonists. Aliment Pharmacol Ther 1999; 13: 959–967.
140 Gisbert JP, Boixeda D, Martín De Argila C, Álvarez Baleriola I, Abraira V, García Plaza A. Unhealed duodenal ulcers despite Helicobacter pylori eradication. Scand J Gastroenterol 1997; 32: 643–650.
141 Hosking SW, Ling TK, Yung MY et al. Randomised controlled trial of short term treatment to eradicate Helicobacter pylori in patients with duodenal ulcer. BMJ 1992; 305: 502–504.
142 Avsar E, Kalayci C, Tözün N et al. Refractory duodenal ulcer healing and relapse: comparison of omeprazole with Helicobacter pylori eradication. Eur J Gastroenterol Hepatol 1996; 8: 449–452.
143 Bianchi Porro G, Parente F, Lazzaroni M. Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralphate alone. Gut 1993; 34: 466–469.
144 Mantzaris GJ, Hatzis A, Tamvakologos G, Petraki K, Spiliadis C, Triadaphyllou G. Prospective, randomized, investigator-blind trial of Helicobacter pylori infection treatment in patients with refractory duodenal ulcers. Healing and long-term relapse rates. Dig Dis Sci 1993; 38: 1132–1136.
145 Wagner S, Gebel M, Haruma K et al. Bismuth subsalicylate in the treatment of H2-blocker resistant duodenal ulcers: Role of Helicbacter pylori. Gut 1992; 33: 179–183.
146 Zheng ZT, Wang ZY, Chu YX et al. Double-blind short-term trial of furazolidone in peptic ulcer. Lancet 1985; i: 1048–1049.
147 Zhao HY, Li G, Guo J et al. Furazolidone in peptic ulcer. Lancet 1985; ii: 276–277.
148 Quintero Diaz M, Sotto Eschobar A. Metronidazole versus cimetidine in the treatment of gastroduodenal ulcer. Lancet 1986; i: 907.
149 Lam SK, Ching CK, Lai KC et al. Does treatment of Helicobacter pylori with antibiotics alone heal duodenal ulcer? A randomized double blind placebo controlled study. Gut 1997; 41: 43–48.
150 Hosking SW, Ling TKW, Chung SCS et al. Duodenal ulcer healing by eradication of Helicobacter pylori without anti-acid treatment: Randomized controlled trial. Lancet 1994; 343: 508–510.
151 Logan RPH, Gummett PA, Misiewicz JJ, Karim QN, Walker MM, Baron JH. One week’s anti-Helicobacter pylori treatment for duodenal ulcer. Gut 1994; 35: 15–18.
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