십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구

Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months