Scandinavian journal of gastroenterology. Supplement
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Scand. J. Gastroenterol. Suppl. · Jan 1996
Comparative StudyCost-effectiveness of Helicobacter pylori eradication therapy in duodenal ulcer disease.
A model analysis applied to Helicobacter pylori eradication found that, following successful healing with omeprazole and H. pylori eradication, virtually all patients were cured and experienced no relapse during the next 5 years. In contrast, almost all of the patients receiving episodic therapy relapsed and, during maintenance therapy with H2-receptor antagonists, most experienced at least one relapse. Although H. pylori eradication initially resulted in higher costs than the alternative therapies, it reduced the risk of recurrence and, for most patients, no future costs were incurred. ⋯ These regimens were also shown to be the most cost-effective. As the difference in costs between the therapies is small compared with the savings that can be achieved by successful H. pylori eradication, it is logical that the eradication strategy with the highest eradication rate is the most cost-effective. The model analysis concludes that H. pylori eradication in patients with duodenal ulcer disease is cost-effective in comparison to episodic therapy with omeprazole or maintenance therapy with ranitidine.
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Scand. J. Gastroenterol. Suppl. · Jan 1996
Comparative StudyHelicobacter pylori reinfection after apparent eradication--the Ipswich experience.
The reported rate of Helicobacter pylori reinfection following eradication therapy is highly variable. In Ipswich, the 14C-urea breath test (UBT) has been used since 1986 as a tool to study H. pylori eradication and reinfection. Updated results from 1182 patients in whom the organism had apparently been successfully eradicated, following a number of different eradication regimens between October 1986 and 31 March 1995, are presented. ⋯ Our data also suggest that the true reinfection rate is particularly low if the eradication therapy chosen has an efficacy of more than 85%. Several effective and well-tolerated 1-week triple H. pylori eradication regimens are now available, and we would advocate their use in preference to the less effective dual regimens where initial eradication rates are lower and there is consequently a higher risk of 'reinfection'. We would predict that even in developing countries with a high prevalence of metronidazole-resistant H. pylori, the 'reinfection' rate would be low if a combination of omeprazole, amoxycillin and clarithromycin were to be used.
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Scand. J. Gastroenterol. Suppl. · Jan 1995
ReviewStress ulcer prophylaxis: gastrointestinal bleeding and nosocomial pneumonia. Best evidence synthesis.
To examine the effect of stress ulcer prophylaxis on gastrointestinal bleeding, pneumonia, and mortality. ⋯ All stress ulcer prophylactic agents appear to be effective in decreasing bleeding. Prophylaxis with sucralfate is associated with a lower rate of nosocomial pneumonia and mortality, providing strong evidence for use of this agent in clinical practice.
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Scand. J. Gastroenterol. Suppl. · Jan 1995
ReviewH2-receptor antagonists an Helicobacter pylori eradication.
To discuss the place of histamine H2-receptor antagonists in eradication therapy of Helicobacter pylori. ⋯ Ranitidine is to be considered as a valuable and safe component of triple therapy against H. pylori in duodenal ulcer patients.
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Scand. J. Gastroenterol. Suppl. · Jan 1994
ReviewTreatment strategies for symptom resolution, healing, and Helicobacter pylori eradication in duodenal ulcer patients.
The introduction of anti-Helicobacter pylori therapy has increased the number of options available for the management of patients with duodenal ulcer disease. The aim of this paper is to summarize current knowledge and use it to form a strategy relevant to the management of patients with duodenal ulcer disease. Four key aspects are addressed. (i) Selection of duodenal ulcer patients for anti-H. pylori treatment. ⋯ At present, there are four effective eradication therapies documented: omeprazole plus amoxycillin or clarithromycin; omeprazole, amoxycillin and metronidazole; 'classic' triple therapy (bismuth, amoxycillin (or tetracycline) and metronidazole); and ranitidine, amoxycillin and metronidazole. (iv) Confirmation of eradication after treatment. This is needed in cases in which the chosen therapy has an efficacy below 80-90%. The test is important to identify those patients who require repeated treatment, before they present with an ulcer relapse.