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October 9, 1996

Practice Guidelines for Treatment of Peptic Ulcer Disease-Reply

Author Affiliations

for the ACG Practice Parameters Committee UCLA School of Medicine Los Angeles, Calif

JAMA. 1996;276(14):1136-1137. doi:10.1001/jama.1996.03540140024013

In Reply.  —Our practice guidelines for treatment of peptic ulcer disease were developed both to "provide firm recommendations" where data supported consensus and "reasonable suppositions" where data were not definitive. Hard choices were needed. Our experts felt obliged to offer their "best guesses" to guide clinicians, rejecting the option of limiting recommendations to points of firm consensus. It would have been preferable to not label these guidelines "Consensus Statement."Dr Olson is correct; the cure rate for Hpylori with omeprazole-clarithromycin therapy was 75% in FDA trials.1 Unfortunately, those data were not available to us at the time of the literature search. Although many published trials are weak, numbers are large; literature summary2 (Table) yielded similar cure rates. Although there are no direct comparisons, the limitations of available data probably comparably affect treatment groups. The consensus among 20 experts (reconsulted May 1996) was that adding metronidazole or amoxicillin would enhance cure rates by 10% to 20%, thereby allowing shorter treatment with lower doses of clarithromycin.