ONE TREATMENT FOR HELICOBACTER

Report #6470 3/28/95

Thirteen years ago, Dr. Barry Marshall first reported that most stomach and intestinal ulcers are caused by a bacteria called helicobacter, but, it's only recently that doctors are learning the best way to cure stomach ulcers.

The major disagreements about the treatment for belching and burning in the stomach are whether all patients need to have a tube put down their mouths into their stomachs or they can just be checked with a simple x ray taken after swallowing barium; whether a blood test or a biopsy is more valuable in diagnosing helicobacter infection; how long to treat helicobacter with antibiotics; and what to do if helicobacter is not eradicated by the first treatment with antibiotics.

All people infected with helicobacter have a positive blood test for that germ, but not all patients with helicobacter will have a positive biopsy for helicobacter. If the doctor biopsies the wrong spot, the test will be negative. Therefore, all patients with ulcer symptoms should have a helicobacter blood test. Another advantage is that the blood test titer will drop three months after a patient is cured with antibiotics. Because 12 years ago, Dr. Marshall recommended treating ulcers with antibiotics for 2 weeks, almost all doctors treat their ulcer patients for 2 weeks. In the last year, many papers have shown that one week treatment with the metronidazole, amoxacillin and omeperazole is as effective as 2 weeks and has far fewer side effects.

Patients who are not cured with first regimen of the metronidazole antibiotic usually are infected with a helicobacter that is resistant to metronidazole and need a second antibiotic regimen that includes clarithromycin and tetracycline.

By Gabe Mirkin, M.D., for CBS Radio News

* Blood tests are more dependable than endoscopy (having a tube put down your throat) to treat and follow helicobacter infections.

1) NA Alsomal, KE Coley, PC Molan, BM Hancock. Role of Helicobacter Pylori Serology in Evaluating Treatment Success. Digestive Diseases and Sciences 1993 (Dec);38(12): 2262-2266.

2) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of Helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10(OCT 1994):1793-1796.

* Initial treatment should be for one week, not two.

1) WA Deboer, WMM Driessen, HVPJ Potters, GNJ Tytgat. Randomized study comparing 1 with 2 weeks of quadruple therapy for eradicating Helicobacter pylori.

2) American Journal of Gastroenterology 89: 11 (NOV 1994):1993-1997.

3) JJY Sung, SCS Chung, TKW Ling, MY Yung, VKS Leung, EKW Ng, MKK Li, AFB Cheng, AKC Li. Antibacterial treatment of gastric ulcers associated with Helicobacter pylori. New England Journal of Medicine 332: 3 (JAN 19 1995):139-142.

4) Hudson N. Successful Helicobacter pylori eradication incorporating a one-week antibiotic regimen. Aliment Pharmacol Therapeut. 1995 FEB;9(1):47-50.

5) Bell GD, et al. Rapid eradication of Helicobacter pylori infection. Aliment Pharmacol Therapeut 1995 FEB;9(1):41-46.

* If you are not cured with the first regimen, you need a different antibiotic treatment.

1) MT Alassi et al: Clarithromycin, tetracycline, and bismuth: A new non-metronidazole therapy for Helicobacter pylori infection. American Journal of Gastroenterology 1994(August);89(8):1203-1205.

2) F Bazzoli, RM Zagari, S Fossi, P Pozzato, G Alampi, P Simoni, S Sottili, A Roda, E Roda. Short-Term Low-Dose Triple Therapy for the Eradication of Helicobacter pylori. European Journal of Gastroenterology & Hepatology 1994(Sept);6(9):773-777.