Model of Helicobacter pylori treatment and disease outcome: a threshold analysis

  • A. Sonnenberg


An infection with Helicobacter pylori and the ensuing gastroduodenitis are considered the most important pathophysiological mechanisms in the development of common peptic ulcer disease that is not secondary to intake of non-steroidal anti-inflammatory drugs (NSAIDs)1,2. Several decision analyses have shown antibiotic eradication of H. pylori to be more cost-effective than other previous treatment modalities of peptic ulcer disease3–5. There is little doubt among gastro-enterologists that all ulcers caused by H. pylori should be treated with antibiotics. Occasionally, other factors may contribute to the development of peptic ulceration, and the correct mode of ulcer management becomes questionable.


Peptic Ulcer Duodenal Ulcer Maintenance Therapy Pylorus Eradication Ulcer Patient 
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  1. 1.
    Graham DY, Go MF. Helicobacter pylori: current status. Gastroenterology. 1993;105:279–82.PubMedGoogle Scholar
  2. 2.
    Fennerty MB. Helicobacter pylori. Arch Intern Med. 1994;154:721–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Sonnenberg A, Townsend WF. Costs of duodenal ulcer therapy with antibiotics. Arch Intern Med. 1995;155:922–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Imperiale TF, Speroff T, Cebul RD, McCullough AJ. A cost analysis of alternative treatments for duodenal ulcer. Ann Intern Med. 1995;123:665–72.PubMedGoogle Scholar
  5. 5.
    Vakil N, Fennerty MB. Cost-effectiveness of treatment regimens for the eradication of Helicobacter pylori in duodenal ulcer. Am J Gastroenterol. 1996;91:239–45.PubMedGoogle Scholar
  6. 6.
    Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray W. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991; 114:257–63.PubMedGoogle Scholar
  7. 7.
    Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991; 115:787–96.PubMedGoogle Scholar
  8. 8.
    Allison MC, Howatson AG, Torrance CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992;327:749–54.PubMedCrossRefGoogle Scholar
  9. 9.
    McCarthy DM. Helicobacter pylori infection and gastroduodenal injury by non-steroidal antiinflammatory drugs. Scand J Gastroenterol. 1991;26(Suppl. 187):9–7.CrossRefGoogle Scholar
  10. 10.
    Graham DY, Lidsky MD, Cox AM et al. Long-term nonsteroidal antiinflammatory drug use and Helicobacter pylori infection. Gastroenterology. 1991;100:1653–7.PubMedGoogle Scholar
  11. 11.
    Loeb DS, Talley NJ, Ahlquist DA, Carpenter HA, Zinsmeister AR. Long-term nonsteroidal anti-inflammatory drug use and gastroduodenal injury: the role of Helicobacter pylori. Gastroenterology. 1992;102:1899–905.PubMedGoogle Scholar
  12. 12.
    Heresbach D, Raoul JL, Bretagne JF et al. Helicobacter pylori: a risk and severity factor of nonsteroidal anti-inflammatory drug induced gastropathy. Gut. 1992;33:1608–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Schubert TT, Bologna SD, Nensey Y, Schubert AB, Mascha EJ, Ma CK. Ulcer risk factors: interactions between Helicobacter pylori infection, nonsteroidal use, and age. Am J Med. 1993; 94:413–18.PubMedCrossRefGoogle Scholar
  14. 14.
    Taha AS, Russell RI. Helicobacter pylori and non-steroidal anti-inflammatory drugs: uncomfortable partners in peptic ulcer disease. Gut. 1993;34:580–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim JG, Graham DY, the Misoprostol Study Group. Helicobacter pylori infection and development of gastric or duodenal ulcer in arthritic patients receiving chronic NSAID therapy. Am J Gastroenterol. 1994;89:203–7.PubMedGoogle Scholar
  16. 16.
    Reinbach DH, Cruickshank G, McColl KEL. Acute perforated duodenal ulcer is not associated with Helicobacter infection. Gut. 1993;34:1344–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Cryer B, Feldman M. Effects of nonsteroidal anti-inflammatory drugs on endogenous gastrointestinal prostaglandins and therapeutic strategies for prevention and treatment of nonsteroidal anti-inflammatory drug-induced damage. Arch Intern Med. 1992; 152:1145–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Graham DY, White RH, Moreland LW et al. and the Misoprostol Study Group. Duodenal and gastric ulcer prevention with misoprostol in arthritis patients taking NSAIDs. Ann Intern Med. 1993;119:257–62.PubMedGoogle Scholar
  19. 19.
    Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med. 1980;302:1109–17.PubMedCrossRefGoogle Scholar
  20. 20.
    First DataBank Division. Price alert. The official guide to average wholesale pricing. November 1993.Google Scholar
  21. 21.
    US Department of Commerce. Survey of current business. September 1993, p. 74.Google Scholar
  22. 22.
    Veldhuyzen van Zanten SJO, Tytgat KMAJ, deGara CJ et al. A prospective comparison of symptoms and five diagnostic tests in patients with Helicobacter pylori positive and negative dyspepsia. Eur J Gastroenterol Hepatol. 1991;3:463–8.Google Scholar
  23. 23.
    Cutler AF, Havstad S, Ma CK, Blaser MJ, Perez-Perez GI, Schubert TT. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995; 109:136–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Sonnenberg A, Townsend WF. Testing for Helicobacter pylori in the diagnosis of Zollinger -Ellison syndrome. Am J Gastroenterol. 1991;86:606–8.PubMedGoogle Scholar
  25. 25.
    Sonnenberg A. Peptic ulcer. In: Everhart JE, editor. Digestive diseases in the United States: epidemiology and impact. US Department of Health and Human Services. Washington, DC: US Government Printing Office, 1994; NIH publication no. 94–1447:357–408.Google Scholar
  26. 26.
    Chiba N, Rao BV, Rademaker JW, Hunt RH. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol. 1992;87:1716–27.PubMedGoogle Scholar

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© Kluwer Academic Publishers and Axcan Pharma 1996

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  • A. Sonnenberg

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