TY - JOUR
T1 - Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori
AU - Marshall, Barry
AU - Warren, Robin
AU - Blincow, E. D.
AU - Phillips, Michael
AU - Goodwin, C. S.
AU - Murray, Raymond
AU - Blackbourn, S.
AU - Waters, Thomas E.
AU - Sanderson, Christopher R.
N1 - In other studies of ulcer relapse, the importance of age, sex, and smoking have been emphasised, zo perhaps because they were the only factors other than continuing ulcer therapy that seemed to make any prognostic difference. How important are they compared with C pylorz? Apparently they are of secondary importance. Once C pylori had been eradicated the patient did well, even if he (or she) smoked, or had a previous history of severe relapsing disease, or had multiple adverse factors. On the other hand, patients with persistent C pylori infection had an adverse prognosis if they had multiple risk factors, or if they smoked. A one-time therapy which both heals duodenal ulcers and stops relapse is, by definition, curative. In future studies the distinction between unhealed ulcers and ulcers which relapse within 12 months of therapy may be unnecessary since both outcomes are really treatment failures. Conversely, by defining treatment success as a patient whose ulcer heals and who remains well for 12 months without therapy, a striking difference is evident between conventional Hz-receptor antagonist therapy and our anti- Cpylori therapy. Treatment success in patients treated with CIM/p was 5%, with CIM/T 14%, with CBS/p 32%, and with CBS/T 56% (fig 6). Our results imply that C pylori is the most important aetiological factor so far described for duodenal ulcer. We propose that detection of C pylori should be part of the routine management of patients with acid peptic disease and eradication of the bacterium a major therapeutic goal. This study was funded by grants from the National Health and Medical Research Council of Australia, the Royal Perth Hospital Research Fund, Gist Brocades, and Pfizer.
PY - 1988/12/31
Y1 - 1988/12/31
N2 - 100 consecutive patients with both duodenal ulcer and Campylobacter pyloriinfection were followed up to see whether eradication of C pylori affected ulcer healing or relapse. Patients were randomly assigned to 8 weeks of treatment with cimetidine or colloidal bismuth subcitrate (CBS), with tinidazole or placebo being given concurrently from days 1 to 10, inclusive. Endoscopy, biopsy, and culture were done at entry, in weeks 10, 22, 34, and 62, and whenever symptoms recurred. There was no maintenance therapy. C pyloripersisted in all of the cimetidine-treated patients and in 95% of those treated with cimetidine/tinidazole, but was eradicated in 27% of the CBS/placebo group and 70% of the CBS/tinidazole group. When C pylori persisted, 61% of duodenal ulcers healed and 84% relapsed. When C pyloriwas cleared 92% of ulcers healed (p
AB - 100 consecutive patients with both duodenal ulcer and Campylobacter pyloriinfection were followed up to see whether eradication of C pylori affected ulcer healing or relapse. Patients were randomly assigned to 8 weeks of treatment with cimetidine or colloidal bismuth subcitrate (CBS), with tinidazole or placebo being given concurrently from days 1 to 10, inclusive. Endoscopy, biopsy, and culture were done at entry, in weeks 10, 22, 34, and 62, and whenever symptoms recurred. There was no maintenance therapy. C pyloripersisted in all of the cimetidine-treated patients and in 95% of those treated with cimetidine/tinidazole, but was eradicated in 27% of the CBS/placebo group and 70% of the CBS/tinidazole group. When C pylori persisted, 61% of duodenal ulcers healed and 84% relapsed. When C pyloriwas cleared 92% of ulcers healed (p
UR - http://www.scopus.com/inward/record.url?scp=0024208785&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(88)90929-4
DO - 10.1016/S0140-6736(88)90929-4
M3 - Article
C2 - 2904568
SN - 0140-6736
VL - 332
SP - 1437
EP - 1442
JO - Lancet
JF - Lancet
IS - 8626-8627
ER -