Does eradication of H. pylori infection benefit the patient with peptic ulcer disease? 

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.