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Background & Aims: It is not clear whether H 2 -receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper GI bleeding and ulcers in high-risk aspirin users., Methods: We studied 270 users of low-dose aspirin (≤325 mg/day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan. After healing of ulcers, subjects with negative results from tests for Helicobacter pylori resumed aspirin (80 mg) daily and were assigned randomly to groups given a once-daily PPI (rabeprazole, 20 mg; n = 138) or H2RA (famotidine, 40 mg; n = 132) for up to 12 months. Subjects were evaluated every 2 months; endoscopy was repeated if they developed symptoms of upper GI bleeding or had a reduction in hemoglobin level greater than 2 g/dL and after 12 months of follow-up evaluation. The adequacy of upper GI protection was assessed by end points of recurrent upper GI bleeding and a composite of recurrent upper GI bleeding or recurrent endoscopic ulcers at month 12., Results: During the 12-month study period, upper GI bleeding recurred in 1 patient receiving rabeprazole (0.7%; 95% confidence interval [CI], 0.1%-5.1%) and in 4 patients receiving famotidine (3.1%; 95% CI, 1.2%-8.1%) (P = .16). The composite end point of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%-14.7%) and 13 patients receiving famotidine (12.4%; 95% CI, 7.4%-20.4%) (P = .26)., Conclusions: In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients receiving an H2RA with the aspirin, although this difference was not statistically significant. ClincialTrials.gov no: NCT01408186., (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)

This study was designed to assess whether the gastroprotective drug, rebamipide, aids in eradication of H. pylori. One hundred twenty patients, endoscopically diagnosed with gastric or duodenal ulcers and H. pylori infection, were randomly allocated to two treatment groups. Sixty patients received 40 mg of omeprazole twice a day, 1500 mg of amoxicillin three times a day, and 300 mg of rebamipide three times a day (group OAR); the other 60 patients received the same dosage of omeprazole and amoxicillin but no rebamipide for two weeks (group OA). All patients subsequently received an H2-receptor antagonist for six weeks. At the end of the treatment, endoscopy was performed to assess the status of the ulcers as well as the extent of H. pylori infection. In the intent-to-treat (73.3 vs 51.7%, P = 0.014) and per-protocol analyses (75.9 vs 55.3%, P = 0.021) the cure rates for H. pylori infection in group OAR were found to be significantly higher than those in group OA. Our findings suggest that rebamipide aids in curing H. pylori infection. This drug does not induce formation of resistant colonies and has few side effects.

Eradication of Helicobacter pylori (HP) has been widely performed, but subsequent upper gastrointestinal lesions associated with HP eradication have been reported. In this study, we investigated the frequency of upper intestinal lesions that developed after successful HP eradication and the course for five years after eradication. Subjects and methods: The subjects were 122 patients with HPpositive gastric ulcer or duodenal ulcer for whom successful eradication therapy with a proton pump inhibitor and antibiotics was performed. Patients did not receive medication after ulcer was healed, and the upper digestive tract was examined by endoscopy 3, 6, and 12 months after eradication and yearly for five years to investigate the development of lesions in the upper digestive tract. Results Duodenal erosion developed in the third month after eradication in 8.6% of the patients. Most of these patients had no subjective symptom and erosion resolved without treatment. Antral stomach erosion was observed in 12% in the third month after eradication. Antral stomach erosion was observed in 8.1% and 4.8% in the second and third year, but not in the fourth and fifth year. Most of these cases were not accompanied by symptoms. The frequency of gastroesophagial reflux disease was only 2.2% one year after eradication, but the frequency remained 2-4% even 2-5 years after eradication. Many cases were accompanied by symptoms. Despite successful eradication, stomach or duodenal ulcer recurred in 10 patients (8.2%) during the period from three months to five years after eradication. Two of 10 patients used NSAID, but the other 8 patients did not. Conclusion Long-term careful observation of ulcer patients is necessary to prevent recurrence of ulceration and development of duodenal erosion, antral gastritis, and gastroesophagial reflux disease, although HP eradication was successful. [ABSTRACT FROM AUTHOR]