Upper GI bleed: peptic ulcer: treating H. pylori infections reduced recurrence more effectively than long-term ranitidine

Clinical bottom line (level 1b)

  1. Patients with a recent upper GI bleed from an H.pylori-infected peptic ulcer who had triple therapy compared with long-term ranitidine were less likely to develop recurrent ulcers (NNT = 15 at 12 months)
  2. There was no clear difference in the rate of ulcer healing.
  3. There was no clear effect on the recurrence of bleeding peptic ulcers.
Sung et al: Digestive Diseases and Sciences 1997; 42 (12): 2524-2528
Expires October 2002

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: university hospital, Hong Kong

247 patients (aged mean 45, 82% male) with an upper GI bleed due to an endoscopically-proven peptic ulcer, and a positive urease test for H. pylori.

Excluded if
  • aged <16
  • history of using NSAIDs in last 8 weeks
  • previous ulcer surgery or H.pylori therapy
  • pregnancy

Control Group: (n = 124, 121 analysed): long-term ranitidine 300 mg po bd for 6 weeks, then 150 mg daily
Experimental Group: (n = 123, 123 analysed): H. pylori eradication therapy: one-week course of bismuth subcitrate 120 mg qds, metronidazole 400 mg qds and tetracycline 500 mg qds. Patients had 300 mg ranitidine daily for that week.

99% followed for 12 months
Outcome notes:
  • ulcer not healed : on repeat endoscopy

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
ulcer not healed 6 weeks 17
(14.1%)		 15
(11.9%)		 15%
(-62% to 56%)		 2.14%
(-6.24% to 10.5%)		 47
(NNT = 9 to infinity;
NNH = 16 to infinity)
recurrence of ulcer 12 months 9
(%)		 1
(.79%)		 89%
(17% to 99%)		 6.64%
(1.7% to 12%)		 15
(9 to 58)
recurrent bleeding ulcers 12 months 3
(2.48%)		 0
(0.0%)		 100%
(0% to 100%)		 2.48%
(-0.29% to 5.25%)		 40
(NNT = 19 to infinity;
NNH = 340 to infinity)

Comments

  1. The study is too small to show any effect on the recurrence of bleeding ulcers.

Citation

  1. Sung JJ, Leung WK, Suen R, et al: one-week antibiotics versus maintenance acid suppression therapy for Helicobacter pylori-associated peptic ulcer bleeding. Digestive Diseases and Sciences 1997; 42 (12): 2524-2528
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer:

Clinical Question.
Patient upper GI bleed from a peptic ulcer with a H.pylori infection
Intervention or Exposure triple therapy
Comparison long-term ranitidine
Outcome ulcer recurrence