Helicobacter
pylori infection is strongly associated with the predominant forms of
peptic ulcer disease and appears to play an important contributory role
in their pathogenesis; thus, it is reasonable to suggest that
eradication of H. pylori infection may benefit patients with
peptic ulcer disease. Although further studies are needed to delineate
fully the role of H. pylori eradication in many other patient
populations, available studies have demonstrated clearly the principal
benefit of eradication in patients with peptic ulcers, a substantial
reduction in the risk of ulcer recurrence (to <10 percent in 1 year).
The evidence is more complete for patients with duodenal ulcers than for
those with gastric ulcers, although the benefits to the two sets of
patients appear to be comparable. The side effects of current regimens
for eradication of H. pylori infection are generally minor and
are outweighed by the benefit of reduced ulcer recurrence. When combined
with standard antisecretory therapy, H. pylori eradication may
contribute to a modest reduction in time to ulcer healing. Moreover,
eradication of H. pylori infection may enhance healing of ulcers
refractory to conventional therapy.
A
separate question is whether H. pylori eradication prevents
future problems in peptic ulcer patients with a history of bleeding or
other complications. Although preliminary data indicate such efficacy,
more definitive data are needed.
The
benefits of eradicating H. pylori infection in patients with
peptic ulcer disease may vary depending on a variety of factors
including those related to the host, the organism, and the environment.
Such factors include patient demographics (age, socioeconomic status,
concurrent illness, behavioral factors), frequency of reinfection, mode
of transmission, and strain variation.
The potential cost savings
associated with treating H. pylori infection have not been
established, but may be substantial. Carefully designed economic
analyses are needed to assess more completely the cost-effectiveness of H.
pylori eradication in peptic ulcer disease patients.
