Peptic Ulcer Disease: How to Confirm a Cure

In our practice, we see many adolescents who are in residentialtreatment facilities or in group foster homes. Whenany of these young persons complain repeatedly of stomachproblems, we test for Helicobacter pylori infection--especiallyif they describe a burning sensation and have notbenefited from a trial of an H2 blocker. Many of these patientshave tested positive for H pylori; one recently had anH pylori antibody level of 457. She is currently receiving a2-week regimen of combination therapy (lansoprazole,amoxicillin, and clarithromycin). We plan to give her anH2 blocker or a proton pump inhibitor for the next month;if she still has symptoms, we will refer her for endoscopy.However, if she feels better, how can we determine whetherthe H pylori infection has been eradicated?
---- Rita C. Stock, MSN, CRNP
Abington, Pa
I agree that it is worthwhile to test for H pylori in patientswhose symptoms suggest ulcer disease. The questionis what to do next. The current management paradigmconsists of 3 stages: test, treat, and confirm cure.A test for active infection, such as a urea breath testor stool antigen test, is best, but a clinical narrative thatstrongly suggests ulcer disease and a positive IgGantibody test can also justify treatment. Before the discoverythat eradication of H pylori infection led to cure ofchronic peptic ulcer disease, antisecretory drugs wereused to heal the ulcers; however, because these agentstreated only the symptoms and had no effect on the underlyingdisease, the condition always recurred.For a patient such as the young woman you describe,prescribe a course of an effective combination therapyfor H pylori infection. Antisecretory drugs and antibioticsare required to cure the infection.After therapy has ended, repeat the test for active infectionto confirm the cure (4 or more weeks after therapyfor the urea breath test, or about 8 weeks for the stoolantigen test).
-- David Y. Graham, MD
  &nbspProfessor of Medicine and Chief of theDigestive Diseases Section
  &nbspBaylor College of Medicine
  &nbspHouston