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Ulcer Treatment: 4 Drugs Better Than 3?

Four-Medication Regimen Beats Out Standard Three-Drug Approach in Study
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WebMD Health News
Reviewed by Louise Chang, MD

Oct. 26, 2009 -- A new, four-drug regimen to wipe out bacteria associated with peptic ulcers and stomach inflammation banished the bugs better than the standard three-drug treatment often used, according to research presented at ACG 2009, the annual meeting of the American College of Gastroenterology in San Diego.

The new, four-drug treatment is "tolerable, and there is excellent compliance," says researcher P. Patrick Basu, MD, an assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York, and chief of the division of gastroenterology and endoscopy at North Shore University Hospital at Forest Hills, N.Y.

Unchecked, the bacteria Helicobacter pylori can lead to irritation of the stomach lining and inflammation of the lining (gastritis) and peptic ulcers, and boost the risk for certain types of stomach cancer.

Detecting Ulcers From H. pylori

An estimated 40% of U.S. residents are infected with H. pylori, according to Basu, but most have no problems with it. Those who are bothered may report a burning pain in the abdomen, nausea, vomiting, burping, bloating, and weight loss.

When the symptoms are bad enough, they prompt a visit to the doctor, who may order a test for the bacteria. The bacteria are detected in a number of ways, including a blood test that looks for antibodies in the blood to indicate exposure, a stool test that looks for evidence of infection, a breath test that checks for the presence of a gas the bacteria produces, or other ways.

Once the bacteria are found in those with troublesome symptoms, the goal is to eradicate them to avoid future problems. Several drug treatment approaches are available, but compliance is often poor, experts say, and the bacteria aren't always eliminated. Resistance to the antibiotics is sometimes a problem, too.

Ulcer Treatment: Study Details

Basu and his colleagues compared a new four-drug regimen -- a seven-day course and a 10-day course -- with a standard 10-day, three-drug treatment. The study was not funded by any drug company.

The three-drug regimen, a standard approach, is called LAC because it included:

  • Lansoprazole ( Prevacid), a proton pump inhibitor (PPI) to reduce stomach acid
  • Amoxicillin (Amoxil), an antibiotic
  • Clarithromycin ( Biaxin), another antibiotic

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