Therapeutic Success with the Suppression of Helicobacter pylori of Intractable Gastric Ulcers

Abstract: Three patients with a long history of gastric ulcers refractory to treatment first with an H2‐receptor antagonist, then with a prostaglandin Et analogue plus an antagonist, and next with a proton‐pump inhibitor, lansoprazole, were given amoxicillin together with an H2‐receptor antagonist, and the ulcers finally healed. The patients were men aged about 60, and two were smokers. Reduction of gastric acidity by lansoprazole may have been satisfactory in these patients because one dose of the drug raised the gastric pH to more than 3.0 for about 97% of the next 24h in all three of the patients, as by the continuous measurement of intraluminal pH. The gastric mucosa of these patients was found to be infected with Helicobacter pylori when tested at the end of treatment with this inhibitor. Their medication was changed from the proton‐pump inhibitor to amoxicillin plus an H2‐receptor antagonist, and all of the ulcers healed within 6 weeks. H. pylori was not detected at the end of this treatment. These results indicate that reduction of gastric acidity alone was insufficient to cure the ulcers in these patients. H. pylori may be related to some ulcers being refractory to many antiulcer agents, even proton‐pump inhibitors.