Selection of patients for treatment of duodenal ulcer infected with Helicobacter pylori.

Ninety patients with endoscopically proven duodenal ulcer were followed for 1 year. All patients were initially treated with an H2-receptor antagonist. Those with more than two relapses within 1 year received triple therapy consisting of colloidal bismuth subcitrate, amoxicillin, and metronidazole. Results showed that 27 patients were symptom-free after one full course of H2 antagonist, 47 had one or two clinical recurrences, and 16 patients had more than two recurrences. Twelve of the latter group were Helicobacter pylori positive and were treated with triple therapy. We conclude that only a minority of duodenal ulcer patients needs to be treated with triple therapy; most of them can be treated with antisecretory agents.