Randomised double blind controlled study of recurrence of gastric ulcer after treatment for eradication of Helicobacter pylori infection

Objective: To determine whether eradication of Helicobacter pylori infection reduces recurrence of benign gastric ulceration. Design: Randomised, double blind, controlled study, Patients were randomised in a 1:2 ratio to either omeprazole 40 mg once daily for eight weeks or the same treatment plus amoxycillin 750 mg twice daily for weeks 7 and 8. A 12 month untreated follow up ensued. Setting: Teaching and district general hospitals between 1991 and 1994. Subjects: 107 patients with benign gastric ulcer associated with H pylori. Main outcome measures: Endoscopically confirmed relapse with gastric ulcer (analysed with life table methods), H pylori eradication, and healing of gastric ulcers (Mantel-Haenszel test). Results: 172 patients were enrolled, Malignancy was diagnosed in 19; 24 were not infected with H pylori; four withdrew because of adverse events; and 18 failed to attend for start of treatment, leaving 107 patients eligible for analysis (35 omeprazole alone; 72 omeprazole plus amoxycillin), In the omeprazole/amoxycillin group 93% (67/72; 95% confidence interval 84% to 98%) of gastric ulcers healed and 83% (29/35; 66% to 94%) in the omeprazole group (P=0.103). Eradication of H pylori was 58% (42/72; 46% to 70%) and 6% (2/35; 1% to 19%) (P<0.001) and relapse after treatment was 22% (16/72) and 49% (17/35) (life table analysis, P<0.001), in the two groups, respectively, The recurrence rates were 7% (3/44) after successful H pylori eradication and 48% (30/63) in those who continued to be infected (P<0.001). Conclusions: Eradication of H pylori reduces relapse with gastric ulcer over one year, Eradication rates achieved with this regimen, however, are too low for it to be recommended for routine use.