Elsevier

Gastrointestinal Endoscopy

Volume 44, Issue 6, December 1996, Pages 683-688
Gastrointestinal Endoscopy

Bacterial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer,☆☆,,★★

https://doi.org/10.1016/S0016-5107(96)70052-4Get rights and content

Abstract

Background: We studied whether different initial bacterial densities of Helicobacter pylori would alter the eradication rate of H. pylori by triple therapy (amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. for 14 days; bismuth subcitrate 120 mg t.i.d. for 28 days) in patients with duodenal ulcer bleeding. Method: One hundred thirty-six cases with duodenal ulcer bleeding and H. pylori infection (proved by rapid urease test and histology during emergency endoscopy) were studied. One hundred twenty-seven of these patients completed a course of triple therapy. In each case, anti-H. pylori IgG titer, gastric biopsies for H. pylori density (score 1 to 5), and evaluation of severity of gastritis were collected at the first endoscopy and 1 month after completion of the triple therapy. Results: The ulcer healing rate was 84.3% (107 of 127) at the time of the second evaluation. The eradication rate of H. pylori was 76.4% (97 of 127). Eradication for H. pylori failed in 30 cases. In these eradication failure cases, initial serologic titer and density of H. pylori were higher than those of eradication success cases. The eradication rate of H. pylori decreased as the initial density of H. pylori increased (density of H. pylori: 1, 88.3%; 2, 83.8%; 3, 74.2%; 4, 68%; 5, 50%). At the second evaluation, the serologic titer was lower and continued to decline in eradication success cases whose mean residual titer ratio (100% × follow-up titer / initial titer) was lower than that of eradication failure cases (57.1% ± 14.6% vs 107.1% ± 24.1%, p < 0.001). The mean residual titer ratio also disclosed an upward trend as the density of H. pylori increased (density of H. pylori 1 to 5: 57.5%, 66.6%, 73.5%, 75.3%, 81.8%, respectively). Conclusions: We suggest routine gastric biopsy to detect both the presence of H. pylori and its density inasmuch as quantitative results may predict the usefulness of triple therapy. The higher the H. pylori density, the less effective triple therapy will be at successful eradication of H. pylori. (Gastrointest Endosc 1996;44:683-8.)

Section snippets

Patient selection criteria

From January 1994 to June 1995, 192 patients with duodenal ulcer bleeding proved by emergency endoscopy were studied. Only patients with H. pylori infection by positive results of rapid urease test (CLO test, Delta Ltd., Perth, Australia)17 and antral biopsy for histology were included. To avoid problems in evaluating H. pylori status, H. pylori-infected patients were excluded for the following conditions: severe medical illness (subject to increased risk of rebleeding and poor drug

Efficacy of early triple therapy

During the study period, 192 patients were proved to have duodenal ulcer bleeding. Our observed prevalence rate of H. pylori in cases of duodenal ulcer bleeding was 78.6% (151 of 192). Fifteen of the 151 H. pylori-infected patients were excluded prior to the study for reasons stated in the Methods section. Among the resulting 136 patients who began early triple therapy, only 6 patients (4.4%) with recurrent bleeding during the first 2 weeks of the study period and 3 patients (2.2%) with poor

DISCUSSION

Eradication of H. pylori changes the natural history of duodenal ulcer disease and is a standard therapy for duodenal ulcer patients, especially those with complications such as bleeding.11 In our study, the prevalence of H. pylori infection in patients with bleeding duodenal ulcer was 78.6% (somewhat lower than the 90% reported for patients with nonbleeding ulcers) determined by CLO test and histologic testing. Precisely because of the lower prevalence of H. pylori, coupled with the

ACKNOWLEDGEMENTS

The authors thank Miss Yen-Lin Wang, Miss Ruey-Jen Tsai, and Mr. T. Randall Gillespie.

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    From the Departments of Internal Medicine, Pathology, Medical Technology, and Emergency, National Cheng Kung University Hospital, Tainan, Taiwan.

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    This manuscript is sponsored by a Research Grant of National Cheng Kung University Hospital (NCKUH 95003).

    Reprint requests: Xi-Zhang Lin, MD, Gastroenterology, National Cheng Kung University Hospital, 138, Sheng Li Road, 704 Tainan, Taiwan.

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