From January 1992 all adult patients with duodenal ulcer who had no history of receiving ulcerogenic drugs in the recent past were offered treatment to heal ulcers and eradicate Helicobacter pylori. To date 710 treatments have been given. At least one month after completion of all treatment a carbon 14 urea breath test (UBT) was performed.
From November 1995 the treatment used was:
388 patients were treated with these quadruple therapies. 320 attended for UBT (aged 17-90, medial 58; 28% women) of which 306 (95.6%) were negative. Two patients were successfully given Pantoprazole 40 mg daily instead of Lansoprazole for reported intolerance. No patient reported prior antibiotic intolerance. There was no statistically significant difference between 4 x 1 (94% success) and (LTCM2) (96.7%) but the healing of ulcers is likely to be quicker with LTCM2 and eradication rates were slightly higher. Overall LTCM2 was significantly better (p<0.01) than the results of all the other triple and quadruple combinations used locally including 4 x 1.
Antibiotic sensitivity testing of Helicobacter pylori in 1992-3, 1996, and 1999 showed no acquired resistance emerging. This quadruple therapy may be recommended for general use in duodenal ulcer patients.
Bateson MC, Mackie A. Quadruple Therapy for Symptomatic Spontaneous Duodenal Ulcer: Simply the Best! Poster presentation at the 8th United European Gastroenterology Week, Brussels, November 2000 Gut 2000; 47 (supplement III): A126-7.
Dr. Alison Mackie, Durham Unit, Durham. Tel: +44 (0)191-333-2219.
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