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March 16, 1994

NIH Consensus Panel Urges Antimicrobials For Ulcer Patients, Skeptics Concur With Caveats

JAMA. 1994;271(11):808-809. doi:10.1001/jama.1994.03510350008003

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A CONSENSUS PANEL seems to be convincing some skeptics that at least most patients with peptic ulcers who have Helicobacter pylori infections should receive antimicrobial therapy.

The biomedical literature has been littered for a decade with mostly small studies suggesting that eradication of H pylori drastically reduces ulcer recurrence, which plagues up to 70% of patients receiving standard antisecretory, antacid, or ulcer-coating therapy.

However, most clinicians have been hesitant to switch patients from these safe and easy standard regimens. Therapy to eradicate H pylori involves two- or three-drug regimens with side effects that are often unpleasant and in rare instances can be serious. Compliance can be a problem.

Whether H pylori itself causes ulcers remains in question as well. While 90% or more of patients with duodenal ulcers and up to 75% of patients with gastric ulcers have H pylori infections, most people who have H pylori infections never develop

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