The pathogenic role of Helicobacter pylori in chronic active gastritis and duodenal ulcer disease is well documented. Ulcer relapse has been reported despite treatment or eradication of H. pylori infection. However, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin, or incomplete eradication of H. pylori may account for these recurrences. Van der Hulst and colleagues conducted a prospective review of patients after active ulcer healing and eradication of H. pylori infection to assess the long-term incidence of ulcer relapse.
Active ulcer healing was confirmed by endoscopy, and eradication of H. pylori was confirmed by culture and histology. A total of 247 patients were enrolled in the study, and 186 patients (141 with duodenal ulcers and 45 with gastric ulcers) met the criteria. Patients were excluded if they had evidence of infection or were taking NSAIDs, aspirin or maintenance therapy with histamine H2 antagonists. Study subjects underwent a series of endoscopic examinations with biopsy every three months for one year. Eradication of H. pylori was accomplished with a variety of therapies. Recurrence was defined as confirmed peptic ulcer disease based on endoscopic examination in patients whose initial ulcer had been healed as confirmed by an initial endoscopic examination.
None of the patients with an original duodenal ulcer had a relapse for a median follow-up period of 2.6 years. In patients with an original gastric ulcer, none had a recurrence for a median follow-up period of 2.5 years. This complete absence of relapse after successful eradication of H. pylori was consistent even in patients with a maximum follow-up of 9.8 years in the gastric ulcer group and 9.2 years in the duodenal ulcer group. Infection did not recur in any of the patients.
The authors conclude that ulcer relapse does not occur after complete eradication of H. pylori, even after a follow-up period of up to 9.8 years. Their results differ from other studies in that their patients did not take NSAIDs or aspirin during the study. Eradication of H. pylori should be mandatory in patients with duodenal or gastric ulcer disease, since eradication helps prevent recurrence.