Preliminary clinical study on gastric ulcer scars and ulcer relapses after Helicobacter pylori eradication therapy

To determine the effect of Helicobacter pylori eradication on the healing of gastric ulcers, endoscopic examinations of gastric ulcer scars and ulcer relapse after eradication therapies or antisecretory therapy were carried out in 24 H. pylori-positive patients with recurrent gastric ulcers located in the gastric angle. Sixteen patients were initially treated with 2-week triple eradication therapy. Subsequently, seven of eight noneradicated cases were retreated with triple therapy, which included metronidazole. Eight patients received antisecretory monotherapy. Endoscopic examinations were performed at 4 weeks and 6 months after the treatments. Gastric ulcer scars were classified endoscopically into three types: Sa, a central depression surrounded by a coarse pattern; Sb, a coarse regenerated pattern; and Sc, a fine pattern indicating matured scar of high quality. Transformations of the scar patterns and ulcer relapse were assessed in 19 patients who showed an ulcer scar at 4 weeks after initial therapy. Thirteen cases in which H. pylori was successfully eradicated, either after initial or re-eradication therapies, mainly showed Sc scars and had no ulcer relapse. Sa scar was mainly observed during H. pylori-positive conditions. Transformation from the Sa to the Sc was observed after successful re-eradication. Ulcer relapses occurred in three patients who showed Sa scar after antisecretory therapy. Although a random study would be needed to obtain a definite conclusion, we suspect that the H. pylori-negative condition after eradication therapies may result in good ulcer healing and may subsequently reduce ulcer relapse.