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Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study.
J Clin Gastroenterol. 2008 Jul; 42(6):744-9.JC

Abstract

BACKGROUND

The role of Helicobacter pylori eradication to cure peptic ulcer disease in patients with cirrhosis is not clear.

AIM

To investigate the course of peptic ulcer disease in cirrhotics, first after healing with either H. pylori eradication or omeprazole therapy and second while on omeprazole maintenance therapy after recurrence.

METHODS

Prospective cohort study in a tertiary-care hospital in Greece. Out of 365 consecutive cirrhotic patients who underwent endoscopy, 67 had peptic ulcer and 30 were enrolled. H. pylori positive patients received eradication therapy and H. pylori negative patients received omeprazole treatment. Follow-up endoscopies were performed at 12 and 24 months or when symptoms recurred. Patients with ulcer recurrence were treated with omeprazole maintenance therapy. The main outcome measurement of the study was peptic ulcer relapse rate during follow-up.

RESULTS

Twenty-eight patients with healed ulcers were followed for up to 2 years. During follow-up, ulcer relapsed in 17 patients (8/18 H. pylori positive and 9/10 H. pylori negative at study entry, P=0.041), including 2 patients who died from ulcer bleeding. No further ulcer relapse was observed in the remaining 15 patients who received omeprazole maintenance therapy for the rest of follow-up. H. pylori negative status (P=0.002) and severity of cirrhosis (P=0.015) at study entry were independently related to shorter peptic ulcer relapse-free time.

CONCLUSIONS

H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients. Therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status.

Authors+Show Affiliations

1st Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

18277886

Citation

Tzathas, Charalambos, et al. "Effect of Helicobacter Pylori Eradication and Antisecretory Maintenance Therapy On Peptic Ulcer Recurrence in Cirrhotic Patients: a Prospective, Cohort 2-year Follow-up Study." Journal of Clinical Gastroenterology, vol. 42, no. 6, 2008, pp. 744-9.
Tzathas C, Triantafyllou K, Mallas E, et al. Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study. J Clin Gastroenterol. 2008;42(6):744-9.
Tzathas, C., Triantafyllou, K., Mallas, E., Triantafyllou, G., & Ladas, S. D. (2008). Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study. Journal of Clinical Gastroenterology, 42(6), 744-9. https://doi.org/10.1097/MCG.0b013e3180381571
Tzathas C, et al. Effect of Helicobacter Pylori Eradication and Antisecretory Maintenance Therapy On Peptic Ulcer Recurrence in Cirrhotic Patients: a Prospective, Cohort 2-year Follow-up Study. J Clin Gastroenterol. 2008;42(6):744-9. PubMed PMID: 18277886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study. AU - Tzathas,Charalambos, AU - Triantafyllou,Konstantinos, AU - Mallas,Elias, AU - Triantafyllou,George, AU - Ladas,Spiros D, PY - 2008/2/19/pubmed PY - 2008/10/8/medline PY - 2008/2/19/entrez SP - 744 EP - 9 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 42 IS - 6 N2 - BACKGROUND: The role of Helicobacter pylori eradication to cure peptic ulcer disease in patients with cirrhosis is not clear. AIM: To investigate the course of peptic ulcer disease in cirrhotics, first after healing with either H. pylori eradication or omeprazole therapy and second while on omeprazole maintenance therapy after recurrence. METHODS: Prospective cohort study in a tertiary-care hospital in Greece. Out of 365 consecutive cirrhotic patients who underwent endoscopy, 67 had peptic ulcer and 30 were enrolled. H. pylori positive patients received eradication therapy and H. pylori negative patients received omeprazole treatment. Follow-up endoscopies were performed at 12 and 24 months or when symptoms recurred. Patients with ulcer recurrence were treated with omeprazole maintenance therapy. The main outcome measurement of the study was peptic ulcer relapse rate during follow-up. RESULTS: Twenty-eight patients with healed ulcers were followed for up to 2 years. During follow-up, ulcer relapsed in 17 patients (8/18 H. pylori positive and 9/10 H. pylori negative at study entry, P=0.041), including 2 patients who died from ulcer bleeding. No further ulcer relapse was observed in the remaining 15 patients who received omeprazole maintenance therapy for the rest of follow-up. H. pylori negative status (P=0.002) and severity of cirrhosis (P=0.015) at study entry were independently related to shorter peptic ulcer relapse-free time. CONCLUSIONS: H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients. Therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/18277886/Effect_of_Helicobacter_pylori_eradication_and_antisecretory_maintenance_therapy_on_peptic_ulcer_recurrence_in_cirrhotic_patients:_a_prospective_cohort_2_year_follow_up_study_ L2 - https://doi.org/10.1097/MCG.0b013e3180381571 DB - PRIME DP - Unbound Medicine ER -