GASTROENTEROLOGY 1997;113:1082–1086 Prevention of Ulcer Recurrence After Eradication of Helicobacter pylori: A Prospective Long-term Follow-up Study

Background & Aims: Short-term follow-up studies show matically reduces ulcer relapse rates. The few studies lower relapse rates of duodenal and gastric ulcers after in patients with gastric ulcers had similar findings. successful Helicobacter pylori eradication. The aim of Only a few studies have followed up on patients with this study was to determine the long-term outcome duodenal ulcers for more than 1 year. All these studof ulcer disease after successful H. pylori eradication. ies report ulcer relapses (3%–22%) despite successful H. Methods: We prospectively studied the long-term effect pylori eradication. Factors clarifying the variance in study of H. pylori eradication on ulcer recurrence rates in results include the varying end points: absence of docupatients after endoscopically proven healing of duodemented initial ulcer disease and ulcer healing; unknown nal or gastric ulcers between 1984 and 1995. Patients H. pylori status at the time of ulcer relapse or at the using nonsteroidal anti-inflammatory drugs (NSAIDs), conclusion of the study; and the assessment of aspirin, or maintenance antisecretory therapy were excure of the infection by H. pylori clearance instead of H. cluded. H. pylori infection was assessed by culture and pylori eradication, a difference leading to high rates of histopathology of gastric biopsy specimens. After endoscopically proven ulcer healing and successful H. pylori H. pylori recrudescence and ulcer relapse rates. eradication, 186 patients with ulcers underwent elecMoreover, the use of nonsteroidal anti-inflammatory tive endoscopy every 3 months during the first year of drugs (NSAIDs), aspirin, or maintenance histamine2-refollow-up and were advised to contact us at symptom ceptor antagonist (H2RA) may influence reported ulcer recurrence. Thereafter, 96 patients were available for relapse rates. To obtain more detailed information on elective half-yearly endoscopies. The 89 patients who the clinical outcome in patients with peptic ulcers after did not choose to undergo the repeated endoscopies prolonged follow-up, we conducted a prospective study were asked about symptom recurrence and to undergo with scheduled follow-up endoscopies every 3 months elective endoscopy in 1995. Results: Successful H. for the first year, after initial ulcer healing (endoscopy) pylori eradication was achieved in 141 patients with and H. pylori eradication (culture and histology) was conduodenal ulcers and 45 patients with gastric ulcers. firmed. Thereafter, elective half-yearly endoscopies were None of the 141 H. pylori–eradicated patients with performed in half of the patients. Patients who declined duodenal ulcers had an ulcer relapse after follow-up of 367 patient-years. Ulcer relapses were also absent in another series of repetitive endoscopies were asked to the 45 H. pylori–eradicated patients with gastric ulcers undergo elective endoscopy at conclusion of the study. after 113 patient-years of follow-up. Conclusions: ExPatients on aspirin, NSAID, or maintenance H2RA thercluding patients taking aspirin or NSAIDs, recurrence apy were excluded. of duodenal or gastric ulcers is completely prevented Materials and Methods after successful H. pylori eradication for up to 9.8 years. Source Population