resistant duodenal ulcers: role of Helicobacter pylori

Fifty nine patients with Helicobacter pylon positive duodenal ulcers that failed to heal after a six week course of treatment with H2 blockers were randomly assigned to one of the following three regimens: (i) bismuth subsalicylate, 600 mg three times daily (n=19), (ii) ranitidine, 300 mg at night (n=20), (iii) bismuth subsalicylate plus ranitidine (n=20). Cumulative ulcer healing rates after four and eight weeks respectively were as follows: bismuth subsalicylate 74% (14/19) and 95% (18/19), ranitidine 40% (8/20) and 65% (13/20), bismuth subsalicylate plus ranitidine 80% (16/20) and 95% (19/20). Bismuth subsalicylate treatment was better than ranitidine at both four and at eight weeks (p<0*05). The clearance rates for H pylon after four weeks were: bismuth subsubsalicylate 58%, ranitidine 0%, bismuth subsalicylate plus ranitidine 55%. After stopping bismuth therapy bacterial recrudescence frequently occurred. After bismuth treatment 86% (19/22) ofulcers had healed ifHpylori had been cleared, whereas only 65% (11/17) had healed ifH pylon persisted (NS). This study shows that bismuth subsalicylate is more effective in the treatment of resistant duodenal ulcers than standard dose ranitidine. It may be that suppression ofH pylori by bismuth subsalicylate promotes ulcer healing. Departments of Gastroenterology and Hepatology and Clinical Microbiology, Medizinische Hochschule Hannover, Germany S Wagner M Gebel W Bar P Lange J Freise