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Long-term outcome of triple therapy in Helicobacter pylori-related nonulcer dyspepsia: a prospective controlled assessment.

OBJECTIVE
To ascertain whether triple therapy alters the history of Helicobacter pylori (HP)-related nonulcer dyspepsia (NUD).


METHODS
Forty-one young (<45 yr) dyspeptic patients were confirmed to be HP-related NUD by serology, rapid urease test, and antral biopsy. Endoscopy excluded the presence of ulcer. These cases were randomly plotted into control (n = 21) and triple therapy (n = 20) groups. In the former group, H2 blocker was given for 2 months and then intermittent antisecretory agents for up to 1 yr. In the latter group, 20 patients received a course of triple therapy and then were treated like the control group. The symptom scores (range: 0-10) were collected on enrollment, and at the end of 2nd, 6th, and 12th months. Each case had serial tests of HP IgG ELISA titer on start, at weeks 2, 4, and 8, at the 6th month, and at the end of the 1st yr. The second endoscopy was done in the 9th wk for eradication survey, and the third endoscopy, at the end of the 1st yr to resurvey the HP status. The histological gradings of biopsy specimens, sampled on each endoscopy, were compared.


RESULTS
In the triple therapy group, the rate of eradication of HP was 75%. At he end of the 2nd month, the HP-eradicated cases of the triple therapy group improved the symptom score more significantly then the noneradicated cases (2.42+/-1.37 vs.4.76+/-1.58, p <0.001). At the ends of the 6th month and 1st yr, the symptom scores of the eradicated cases improved more significantly than those of the control group (6th month, 0.61+/-1.18 vs.] 2.66+/-2.06; 1st yr, 0.82+/-1.17 vs.] 3.56+/-2.89, p <0.001). The decline trend of ELISA titers occurred only in eradicated cases and became significantly evident from the 4th wk (0.30+/-0.15 vs.] 0.49+/-0.07, p <0.05) and thereafter. Both acute and chronic pathological grading was improved in the triple group at the end of the 1st yr (acute, 1.95-0.46; chronic, 1.9-0.92; p <0,01)


CONCLUSION
Compared with control therapy at 1 yr, triple therapy showed greater symptomatic, serological, and histological improvements. Therefore, triple therapy is beneficial to symptomatic HP-related NUD.