Management of duodenal ulcers in patients infected with Helicobacter pylori
- Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
- Professor of Medicine
- University of California, San Diego
Peptic ulcer disease continues to be a common problem, although the incidence of duodenal ulcers has declined in recent decades . Different factors have been implicated as etiologies for DUs, including diet, stress, smoking, and overproduction of gastric acid. However, the majority of patients with duodenal ulcers (DU) are infected with Helicobacter pylori (H. pylori). (See "Association between Helicobacter pylori infection and duodenal ulcer".)
The management of patients with H. pylori infection and DU disease will be reviewed here. Other aspects of H. pylori infection are discussed separately.
ERADICATION OF H. PYLORI
All patients with duodenal ulcers (DUs) associated with H. pylori infection should undergo therapy to eradicate the organism [2-4]. (See 'Treatment regimens for H. pylori' below.) This recommendation is based upon overwhelming data showing that cure of H. pylori infection reduces ulcer recurrence and complications such as bleeding [5-8]. In a study of 100 infected patients with DU, eradication of the infection was associated with a higher rate of healing (92 versus 61 percent when H. pylori persisted after treatment) and a lower rate of recurrence during a 12-month follow-up (21 versus 84 percent). (See 'Disease recurrence' below.)
Empiric treatment versus specific testing — In settings where the prevalence of H. pylori in DU is greater than 90 percent [9,10], empiric therapy for the infection is reasonable for uncomplicated cases .
In the United States, the prevalence of H. pylori in DU appears to be considerably less than 90 percent. (See "Unusual causes of peptic ulcer disease".) The prevalence of H. pylori is also lower in patients with complicated DUs (ie, those complicated by bleeding or perforation) compared with those with uncomplicated disease [12-14]. Patients with H. pylori negative ulcers appear to have a significantly worse outcome especially if treated empirically for infection . Thus, documenting infection in patients with DU (uncomplicated or complicated) is an appropriate caution prior to initiating antimicrobial therapy. (See "Indications and diagnostic tests for Helicobacter pylori infection".)
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- ERADICATION OF H. PYLORI
- Empiric treatment versus specific testing
- Uncomplicated duodenal ulcers
- Complicated duodenal ulcers
- Factors influencing treatment outcome
- Disease recurrence
- Nonsteroidal antiinflammatory drugs
- Recently bleeding gastric or duodenal ulcers
- TREATMENT REGIMENS FOR H. PYLORI
- TESTING FOR H. PYLORI FOLLOWING ERADICATION
- COST-EFFECTIVENESS OF ERADICATING H. PYLORI
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS