Lansoprazole-based triple therapy versus ranitidine bismuth citrate-based dual therapy in the eradication of Helicobacter pylori in patients with duodenal ulcer: a multicenter, randomized, double-dummy study

BACKGROUND

The optimal treatment regimen for eradication of Helicobacter pylori in patients with duodenal ulcer has yet to be determined. Based on a search of MEDLINE, no studies have been performed comparing a proton pump inhibitor-based triple therapy regimen with a ranitidine bismuth citrate (RBC)-based dual therapy regimen, both containing clarithromycin.

OBJECTIVE

This study was undertaken to compare the efficacy of lansoprazole (LAN)-based triple therapy with that of RBC-based dual therapy in H pylori-infected patients with duodenal ulcer.

METHODS

Patients were randomized to receive either 1 week of triple therapy with LAN 30 mg BID, clarithromycin 500 mg BID, and tinidazole 500 mg BID, followed by 3 weeks of LAN 30 mg BID, or 2 weeks of dual therapy with RBC 400 mg BID plus clarithromycin 500 mg BID, followed by 2 weeks of RBC 400 mg BID. Eradication of H pylori was defined as negative results on both the urease quick test and histologic examination > or =4 weeks after the end of treatment. Duodenal healing and recurrence rates were assessed endoscopically at 8 weeks and 6 months. A per-protocol (PP) analysis was conducted for each efficacy end point. Also conducted were an intent-to-treat (ITT) analysis in which patients with missing data were considered failures, and an observed analysis (OBS), which included patients with an evaluable result after treatment, regardless of compliance.

RESULTS

One hundred eighty-five patients (126 men, 59 women; age range, 18-76 years; mean age, 43 years) were enrolled and randomized to treatment. In the LAN and RBC groups, respectively, H. pylori eradication rates were 92.6%, 93.1%, and 72.8% versus 78.6%, 77.9%, and 64.5% in the PP (P = 0.02), OBS (P = 0.01), and ITT analyses. The corresponding duodenal ulcer healing rates were 98.6%, 98.7%, and 83.7% versus 90.8%, 91.5%, and 81.7%; these differences were not statistically significant. Side effects were mild, occurring in 20.7% of LAN patients and 17.2% of RBC patients. Ulcer recurred in 2 RBC patients. No difference was observed between treatments in terms of the occurrence of gastritis or improvement of symptoms.

CONCLUSION

Based on the results of the PP and OBS analyses, LAN-based triple therapy was superior to RBC-based dual therapy for the eradication of H. pylori in patients with duodenal ulcer.

[Prevalence and features of peptic ulcers in the elderly: a retrospective study on a not hospitalized population aged 65 or over]

BACKGROUND

The prevalence of peptic ulcer increases with aging. Data relative to peptic ulcer in the elderly are around 5.2% to 9.9%. The aim of the present study was to evaluate the prevalence and the features of peptic ulcer in a non hospitalized population aged 65 or over.

METHODS

We performed, for the first time, EGDS on 706 patients with symptoms related to the superior gastroenteric tract. We considered the following risk factors: familiarity for peptic disease, habits, eventual use of FANS, infection of Hp.

RESULTS

Our data show that peptic ulcer increases with aging and with physiopathological age-related changes. 114 (16.1%) patients were affected by DU; 84 (11.9%) patients were affected by GU Symptoms thereafter were not clear: epigastralgy was present in 46.4% of patients affected by GU; pyrosis, belchings, swellings, epigastric headness were present in 37.7% of patients with DU. Several times PU may arise with some complications: melena was present in 14.9% of patients with DU vs 11.9% of patients with GU, hematemesis was present in 1.7% of patients with DU vs 5.9% of patients with G.U. The most important risk factor was the infection of Hp, at was present in 71.9% patients with GU and 81.6% patients with DU FANS assumption, often with high dose, was present in 30.9% of patients with GU and 18.4% of patients with DU.