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Diagnosis and eradication of Helicobacter pylori in patients with duodenal ulceration in the community.

Author(s): Abbas SZ, Abbas AB, Crawshaw A, Shaw S, English J, McGovern D, Vivian G, Dalton HR

Affiliation(s): Gastrointestinal Unit, Royal Cornwall Hospital, Truro, The Cornwall General Practice Training Group, Truro, UK.

Publication date & source: 2003-03, J Pak Med Assoc., 53(3):90-4.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To determine the value of Helicobacter pylori (Hp) serology in diagnosis of active Hp infection in patients with documented duodenal ulcer (DU) and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. DESIGN OF STUDY: Prospective, single-blinded, randomised trial. METHODS: One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test (UBT). Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs (OCM) or tinidazole 500 mgs (OCT). Eradication was confirmed by a repeat UBT. RESULTS: Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT (100%) had a significantly better eradication rate than OCM (87.8%), p = 0.023. There was no difference in side effects. CONCLUSION: (1) Positive Hp serology in patients with DU does not always mean active infection and (2) for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp.

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