ANN ARBOR, Mich.--Millions of people with a history of peptic ulcer disease continue to receive unnecessary treatment, according to researchers at the University of Michigan Medical Center.
The U-M study, which was recently published in the American Journal of Gastroenterology, concluded that people with ulcer disease who are being treated with acid-blocking medication should now be tested to determine if they harbor the H. pylori bacteria---whether or not they have any ulcer symptoms. The U-M researchers reported that prompt diagnosis and treatment for H. pylori infection improved patient health and saved money.
It has become widely accepted in recent years that ulcer disease is usually caused by H. pylori bacterial infection. If a newly diagnosed patient tests positive for H. pylori, the recommended course of action is antibiotic treatment to eradicate the bacteria---a regimen that nearly always cures the disease in a matter of weeks.
However, millions of people were diagnosed before the link between ulcer disease and H. pylori was documented. The large majority have been receiving ulcer treatment---sometimes for several years---with acid-blocking (or antisecretory) medication. It is this group the U-M researchers examined.
The study team, led by A. Mark Fendrick, M.D., assistant professor of internal medicine at U-M, used a computer simulation of ulcer patients to compare the clinical and economic outcomes for subjects divided into two treatment groups. One group received medication to immediately eradicate the H. pylori bacteria. Patients also halted antisecretory maintenance therapy. The second group continued antisecretory maintenance therapy with H. pylori eradication used only if symptoms recurred.
The analytical model estimated that after one year, patients who received immediate H. pylori eradication had fewer months with ulcers, fewer ulcer symptoms and lower treatment cost.
"While the dramatic benefits of H. pylori eradication in patients with newly diagnosed peptic ulcer disease are well-documented," says Fendrick, "the benefits in terms of ulcer reduction and health care cost savings may be greater in the larger number of patients with previously documented peptic ulcer disease in whom the diagnosis of H. pylori was never established."
The study determined that after one year, patients who received immediate H. pylori treatment had a 22 percent lower rate of ulcer recurrence, 10 percent fewer ulcer symptoms and the cost-per-patient was reduced by 24 percent compared with those receiving continued acid-blocker treatment (strategy two).
For a small percentage of patients, cessation of antisecretory treatment resulted in the return of symptoms from other gastrointestinal ailments. Even in these cases, Fendrick says, patients still benefit because the H. pylori bacteria is eliminated and they can simply go back to their former treatment for the other gastrointestinal symptoms.
H. pylori is easily diagnosed with a blood test that can be performed in a doctor's office. For patients testing positive, H. pylori is treated with a two-week regimen---usually a combination of two antibiotics and a medication that decreases acid levels in the stomach. Studies have shown that ulcer recurrence is extremely rare after successful H. Pylori eradication. The long-term impact of H. pylori is still being studied, but it has been classified by the World Health Organization as having a potential link to stomach cancer.
"Many ulcer patients take medication daily, without symptoms, to prevent their ulcer from recurring," says Fendrick. "Now we have a way to trade that drug use with a very short and safe medical regimen that will lead to a peptic ulcer disease cure."