Has the Impact of Helicobacter pylori Therapy on Ulcer Recurrence in the United States Been Overstated?

Laine, Loren; Hopkins, Robert J.; Girardi, Luigi S

doi:10.1111/j.1572-0241.1998.452_a.x

Cited by 100 publications

(85 citation statements)

References 20 publications

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“…GI-drug costs ›42 ›18 (p = .02 a ) PPI costs ›11 ›12 (p = .84) % on GI-drugs (PPI) 100% (21%) 37% (43%) Non-Ulcer (n = 67) GI-drug costs ›38 ›38 (p = .96) PPI costs ›18 ›32 (p = .02 a ) % on GI-drugs (PPI) 66% (32%) 33% (68%) Non-Ulcer chronic (n = 44) GI-drug costs ›58 ›29 (p = .008 a ) PPI costs ›27 ›23 (p = .58) % on GI-drugs (PPI) 100% (32%) 41% (67%) All (n = 102) GI-drug costs ›33 ›34 (p = .82) PPI costs ›14 ›28 (p = .005 a ) % on GI-drugs (PPI) 61% (29%) 33% (59%) All chronic (n = 63) GI-drug costs ›53 ›26 (p = .0007 a ) PPI costs ›22 ›20 (p = .62) % on GI-drugs (PPI) 100% (29%) 40% (60%) a significant on a 95% CI-level. et al [15] found that 20% of ulcer recurrence was neither NSAID nor H. pylori induced. The findings of Laine et al are not necessarily true for the Netherlands, nevertheless they could explain some of the post eradication users.…”

Section: Discussionmentioning

confidence: 98%

Pharmacoeconomics of Gastrointestinal Drug Utilisation Prior and Post Helicobacter pylori Eradication

Klok¹,

Veen²,

Werf³

et al. 2004

Helicobacter

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Section: Discussionmentioning

confidence: 98%

Pharmacoeconomics of Gastrointestinal Drug Utilisation Prior and Post Helicobacter pylori Eradication

Klok¹,

Veen²,

Werf³

et al. 2004

Helicobacter

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“…Recently, it has been reported that the duodenal ulcer recurrence rate for patients with H. pylori eradication after therapy may be higher within the USA (» 20%). 71 Geographic variations in the duodenal ulcer recurrence rates may very well Figure 4. Overall 12-month duodenal ulcer recurrence rates post-therapy, combining treatments, from controlled and uncontrolled clinical studies for patients with H. pylori eradication (H. pylori Ave) and those remaining H. pylori positive (H. pylori +ve) at least 4 weeks after therapy, categorized by whether eradication was achieved using omeprazole and antimicrobial agents or bismuth and antimicrobial agents.…”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori eradication as a surrogate marker for the reduction of duodenal ulcer recurrence

Ga¹,

Lj²,

Johnson³

et al. 1998

Aliment Pharmacol Ther

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Objectives: An abundance of data exists documenting the association of H. pylori eradication with the reduction in duodenal ulcer recurrence. Aim: To evaluate the validity of using H. pylori eradication as a surrogate marker for the reduction in duodenal ulcer recurrence using rigorously controlled studies. Methods: Three controlled clinical trials were conducted in patients with uncomplicated, active duodenal ulcers. Patients were treated with various combinations of omeprazole and amoxycillin. Ulcer healing and H. pylori eradication were assessed. For patients whose duodenal ulcer healed, duodenal ulcer recurrence was determined over a 6‐month period in patients with H. pylori eradication and those remaining positive for H. pylori at least 4 weeks after treatment. To support the data obtained from these clinical trials, a search of the medical literature was conducted to identify additional human clinical trials in which duodenal ulcer recurrence rates were measured and categorized by H. pylori status at least 1 month post‐treatment. Results: In 11 controlled trials, the overall 6–18‐month duodenal ulcer recurrence rate was 54% among patients remaining positive for H. pylori at least 4 weeks after treatment compared to 6% among patients with H. pylori eradication following treatment. This finding was corroborated by the uncontrolled trials, in which the duodenal ulcer recurrence rate was 64% among patients found to be H. pylori‐positive and 6% for patients found to be H. pylori‐negative at least 4 weeks after treatment. A time course of duodenal ulcer recurrence rates using pooled data from both controlled and uncontrolled studies demonstrated that duodenal ulcer recurrence rates for H. pylori‐negative patients persisted for up to 4 years following treatment. Duodenal ulcer recurrence rates for H. pylori‐positive patients increased for the first year, then levelled off. A comparison of the duodenal ulcer recurrence rates for different treatment regimens revealed that eradication regimens based on omeprazole plus antibiotics and bismuth plus antibiotics exhibited similar duodenal ulcer recurrence rates for H. pylori‐positive and ‐negative patients. Conclusion: Regardless of treatment regimens, H. pylori eradication produced a consistent and significant reduction in duodenal ulcer recurrence. Therefore H. pylori eradication, 4 weeks post‐therapy, can be used as a surrogate marker for reduced duodenal ulcer recurrence in investigational clinical trials.

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“…Those receiving long-term treatment with H 2 -receptor antagonists have recurrence rates of 30%/year. In contrast, the recurrence rate within 1 year after H. pylori eradication therapy is less than 20%, which has been shown in a number of studies, including a meta-analysis of double-blinded, randomized trials of duodenal ulcer patients with H. pylori [22]. Similar trials show that H. pylori eradication reduces the recurrence rate for gastric ulcers [23].…”

Section: Gastric Ulcer and Duodenal Ulcermentioning

confidence: 99%

How <i>Helicobacter pylori</i> Changed the Life of Surgeons

Kleeff¹,

Frieß²,

Büchler³

2003

Dig Surg

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Helicobacter pylori infection has been identified as a pathogenic factor in a number of gastroduodenal diseases, most importantly in gastric and duodenal ulcer disease. This association and the development of H. pylori eradication therapies has had a tremendous influence on the surgical therapy for these disorders. Decades ago, surgery was the therapy of choice for gastric and duodenal ulcers. Now, however, the first line of therapy includes treatment of H. pylori infection, suppression of gastric acid secretion, and protection of gastric mucosal barriers combined with a range of endoscopic procedures. These developments have had a major impact on the indications for surgery in benign gastroduodenal diseases. In addition, advances in our understanding of the pathogenetic mechanisms of H. pylori infection have also changed our views of gastric mucosa-associated lymphoid tissue lymphoma, gastric cancer, and gastroesophageal reflux disease.

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Has the Impact of Helicobacter pylori Therapy on Ulcer Recurrence in the United States Been Overstated?

Cited by 100 publications

References 20 publications

Pharmacoeconomics of Gastrointestinal Drug Utilisation Prior and Post Helicobacter pylori Eradication

Pharmacoeconomics of Gastrointestinal Drug Utilisation Prior and Post Helicobacter pylori Eradication

Helicobacter pylori eradication as a surrogate marker for the reduction of duodenal ulcer recurrence

How <i>Helicobacter pylori</i> Changed the Life of Surgeons

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