Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study
Date
1998
Authors
Hawkey C.J.
Tulassay Z.
Szczepanski L.
Van Rensburg C.J.
Filipowicz-Sosnowska A.
Lanas A.
Wason C.M.
Peacock R.A.
Gillon K.R.W.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background. The effect of Helicobacter pylori in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) is unclear. We investigated the effects of H pylori eradication in patients with current or previous peptic ulceration, dyspepsia, or both who continued to use NSAIDs. Methods. 285 patients were randomly assigned omeprazole 20 mg, amoxycillin 100 mg, and clarithromycin 500 mg, twice daily (n = 142, H pylori eradication treatment), or omeprazole with placebo antibiotics (n = 143, controls) for 1 week. All patients received omeprazole 20 mg once daily for 3 weeks until endoscopy, and, if the ulcer was not healed, 40 mg once daily until repeat endoscopy at 8 weeks. Ulcer-free patients with mild dyspepsia continued NSAIDs but not antiulcer treatment. We investigated ulcers with endoscopy at 1, 3, and 6 months and with carbon-13-labelled urea breath test at 3 months. Findings. The estimated probability of being ulcer-free at 6 months was 0.56 (95% CI 0.47-0.65) on eradication treatment and 0.53 (0.44-0.62) on on control treatment (p = 0.80). Time to treatment failure did not differ between groups for ulcers or dyspepsia alone, per-protocol analysis, or final H pylori status. 66% (58-74) of the eradication group compared with 14% (8-20) of the control group had a final negative H pylori result (p < 0.001). Fewer baseline gastric ulcers healed among eradication-treatment patients than among controls (72 vs 100% at 8 weeks, p = 0.006). Interpretation. H pylori eradication in long-term users of NSAIDs with past or current peptic ulcer or troublesome dyspepsia led to impaired healing of gastric ulcers and did not affect the rate of peptic ulcers or dyspepsia over 6 months.
Description
Keywords
amoxicillin, clarithromycin, diclofenac, indometacin, naproxen, nonsteroid antiinflammatory agent, omeprazole, urea, abdominal pain, adult, aged, article, breath analysis, clinical trial, controlled study, diarrhea, dyspepsia, endoscopy, female, gram negative infection, helicobacter pylori, human, major clinical study, male, nausea, oral drug administration, peptic ulcer, priority journal, randomized controlled trial, treatment outcome, ulcer healing, Adolescent, Adult, Aged, Aged, 80 and over, Amoxicillin, Anti-Inflammatory Agents, Non-Steroidal, Clarithromycin, Dyspepsia, Female, Helicobacter Infections, Helicobacter pylori, Humans, Life Tables, Male, Middle Aged, Omeprazole, Peptic Ulcer, Recurrence, Risk Factors
Citation
Lancet
352
9133
352
9133