Maintenance treatment vs. Helicobacter pylori eradication therapy in preventing rebleeding of the peptic ulcer disease. A clinical trial and follow-up for two years

Martínez, Carlos M. Pina; Grávalos, R G; Cedenilla, Ana Gómez; Pajares, J. M.

doi:10.1016/0016-5085(95)23492-6

Cited by 19 publications

(5 citation statements)

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“…The control groups in these studies had recurrent hemorrhage rates of 33% and 27% [21,22]. Other studies show a difference in ulcer recurrence rates, although no significantly different hemorrhage recurrence rate [23]. Therefore, the role of definitive acid suppression for long-term eradication of bleeding risk for ulcer in the era of H. pylori is at least in question.…”

Section: Treatment Treatment Surgerymentioning

confidence: 94%

Surgical management of complicated ulcer disease

Martin

Bang²

2007

Curr Treat Options Gastro

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The advent of excellent acid-suppressing medications and the not-so-recent realization of the importance of Helicobacter pylori have markedly altered the physician's management of ulcer-related problems. Although the investigation of acid-peptic disorders helped to launch the modern understanding of abdominal surgery, the majority of operative interventions are now aimed at managing emergent problems that arise from ulcers. There are a waning number of surgeons with extensive experience in the operations that will be described in this report. The global management of patients who suffer from ulcer-related problems will require close cooperation among and between specialties, as well as clear understanding of our respective capabilities and limitations.

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Section: Treatment Treatment Surgerymentioning

confidence: 94%

Surgical management of complicated ulcer disease

Martin

Bang²

2007

Curr Treat Options Gastro

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“…Several randomized trials clearly show that in patients with bleeding H. pylori-positive ulcers cure of the infection prevents both the recurrence of the ulcer and bleeding [32][33][34][35]. In a study from Spain [36], 6 of 84 patients (7.1%) in whom H. pylori was eradicated had recurrence, two with rebleeding (2.3%), compared with 13 of 41 patients (31.7%) receiving ranitidine maintenance therapy, five with rebleeding (12.5%). Although the difference between ulcer recurrence rates was statistically significant (p Ͻ 0.01), the difference between the two rebleeding rates was not.…”

Section: Helicobacter Pylori and Bleedingmentioning

confidence: 98%

Surgical Treatment of Complicated Duodenal Ulcers: Controlled Trials

Millat¹,

Fingerhut

Borie³

2000

World j. surg.

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Indications for surgery of duodenal ulcer (DU) have changed radically because of the efficacy of H(2)-antagonists, endoscopic procedures, and eradication of Helicobacter pylorus. The aim of this study was to analyze the current literature to determine if definitive surgery is still relevant for complicated DU (bleeding, perforation, gastric outlet obstruction). Two studies have compared early to late surgery in terms of bleeding. One recommended early surgery (significant reduction in mortality) in the elderly, but no statistically significant difference was found when analyzed with "intention to treat." In the other, mortality with early surgery was five times higher than with expectant therapy (when it was possible). Two studies comparing different surgical techniques for bleeding favored the radical procedure. Of at least 15 studies comparing endoscopic treatments, however, none has compared endoscopic therapy to surgical intervention for bleeding DU. One trial, comparing nonoperative to surgical treatment for perforation, found similar rates of morbidity, intraabdominal abscess, and mortality; but the hospital stay was longer (p < 0.001). Nonoperative treatment failed more often (p < 0.05) in patients over age 70. In three trials, postoperative morbidity (excepting wound sepsis in one) was not significantly increased by definitive surgery, with less ulcer recurrence (p < 0.05) compared with simple closure. Laparoscopy (versus laparotomy) was shown to take longer (p < 0.001) but required less postoperative analgesics (p < 0.03); there were no statistically significant differences as concerns the duration of nasogastric aspiration, intravenous drips, hospital stay, time to resume normal diet, Visual Analogous Scale pain scores for the first 24 hours after surgery, morbidity, reoperation rate, or mortality. Of 48 laparoscopic patients, 11 (23%) underwent conversion to open surgery. Three surgical techniques [highly selective vagotomy (HSU) + gastrojejunostomy (group 1), HSV + Jaboulay gastroduodenostomy (group 2), or selective vagotomy (group 3) + antrectomy) for gastric outlet obstruction (GOO)] showed that although postoperative results were similar (except wound sepsis in one trial), long-term Visick scores were significantly (p < 0.01) better in group 1 than in group 2, but not in group 3. Further studies are needed to determine the exact prevalence of Helicobacter pylori in complicated DU and to compare (1) definitive to minimal surgery (stop the bleeding or close the perforation) combined with antisecretory drugs and eradication of H. pylori; (2) surgery to endoscopic treatment combined with eradication of H. pylori; and (3) for GOO, surgery to balloon dilatation combined with eradication of H. pylori.

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“…Maintenance treatment is an alternative approach to reduce the risk of recurrent bleeding [70]. In a nonrandomized study with 1 year follow-up, recurrent bleeding was more effectively reduced by cure of H. pylori infection than by long-term maintenance therapy [71]. These and other studies have shown that recurrent bleeding is virtually abolished if patients undergo H. pylori eradication therapy.…”

Section: Late Outcomementioning

confidence: 98%

Trends in Peptic Ulcer Bleeding and Surgical Treatment

2000

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An evidence-based approach is followed, with grading of evidence by study design, to evaluate surgical treatment of a bleeding peptic ulcer. In contrast to endoscopic treatment, reports of surgical treatment are rare, with only five randomized trials having been identified. Epidemiologic studies have demonstrated that the incidence of emergency surgery has not changed despite major improvements with endoscopic treatment. There are no proven alternatives to emergency operation for massive bleeding uncontrollable by endoscopic procedures. There is some debate about surgery for rebleeding, but no randomized trial has assessed whether a second endoscopic treatment alone is preferable to surgery with or without repeated endoscopic treatment. Concerning the type of operative procedure, the existing body of evidence, including two randomized studies, indicates that patients are best served by a relatively aggressive surgical approach. Today the value of these studies is limited owing to prevention of ulcer recurrence by eradication and technical improvements of local procedures (e.g., arterial ligation). Early elective surgery was tested in two randomized studies and several uncontrolled series, which demonstrated that it may be beneficial in high risk groups and harmful in others. Indications for early elective surgery should be refined taking into account updated prognostic information and more effective endoscopic treatment. Because of a new understanding of ulcer disease the role of surgery has changed markedly within the last years, no longer aiming to cure the disease but primarily to stop the hemorrhage. Evidence, however, is not derived from properly randomized controlled trials but is based on theoretic arguments and knowledge from studies not primarily dealing with operative treatment.

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Maintenance treatment vs. Helicobacter pylori eradication therapy in preventing rebleeding of the peptic ulcer disease. A clinical trial and follow-up for two years

Cited by 19 publications

References 0 publications

Surgical management of complicated ulcer disease

Surgical management of complicated ulcer disease

Surgical Treatment of Complicated Duodenal Ulcers: Controlled Trials

Trends in Peptic Ulcer Bleeding and Surgical Treatment

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