One-Week Antibiotics versus Maintenance Acid Suppression Therapy for Helicobacter pylori-Associated Peptic Ulcer Bleeding

Bleeding peptic ulcer is the most importantcause of upper gastrointestinal bleeding. Our aim was tocompare the effect of anti-Helicobacter therapy withmaintenance treatment of H2-receptorantagonist in the prevention of relapses of ulcer andbleeding. Patients with bleeding duodenal or gastriculcers and H. pylori infection were randomized toreceive either a one-week course of triple therapy with bismuth subcitrate, metronidazole, andtetracycline plus ranitidine or a six-week course ofranitidine 300 mg/day. After the ulcers healed, theantibiotic-treated patients were not given anymedication, whereas the ranitidine-treated patientscontinued to receive a maintenance dose of 150 mg/day.One hundred twenty-six patients were randomized toreceive anti- Helicobacter therapy and 124 patients toreceive long-term ranitidine. H. pylori eradication wasachieved in 98.2% in those who received triple therapyand 6.1% in those who received ranitidine (P <0.0001). At the six-week follow-up, ulcer healing was documented in 88.2% in those who receivedtriple therapy and 86.1% in those who receivedranitidine (P = 0.639). Recurrent ulcer developed innine of the ranitidine-treated patients and three ofthem presented with recurrent upper gastrointestinal bleeding.One patient in the antibiotic group developed recurrentulcer without rebleeding (P = 0.01). It is concludedthat eradication of H. pylori is sufficient for the prevention of recurrent bleedingulcers.