• HASSAN KHUDER RAJAB Department of Pharmacology, College of Medicine, Tikrit University, Iraq
  • ALI ESMAIL AL-SNAFI Department of Pharmacology, College of Medicine, Thi qar University, Iraq



Peptic ulcer, Eradication therapy, H pylori, Urea breath test


Objective: This study was performed to detect the recurrence rate for two years after eradication therapy of peptic ulcer.

Methods: Sixty-nine patients included in this study in Kirkuk city from January 2004 to January 2005 as 1st year follow up, and 49 patients from January 2005 to January 2006 as second year follow up study. A urea breath test and re-endoscopic examination were carried out to confirm peptic ulcer recurrence. A questionnaire was prepared to take the history of the disease and other relevant data of each patient.

Results: The recurrence was occurred in 6 (8.7%) and 8 patients (16.33%) in the 1st and 2nd years after eradication therapy. Highly risk of recurrence was smoking, age below 50 y and stress in 1st year follow up, and stress was the highly risk in the 2nd year follow up.

Conclusion: After triple and quadruple therapy of peptic ulcer, the recurrence is low, However, the possibility of H. pylori resistance should be considered.


1. Al-Snafi AA, Rijab HKH. The efficacy of triple and quadruple therapy for the treatment of peptic ulcer disease. J Pharm Sci 2005;1:36-44.
2. Mihmanli M, Isgar A, Kabukcuoglu F, Turkay B, Cikla B, Baykan A. Effect of Helicobacter pylori in perforation of duodenal ulcer. Hepatogastroenterology 1998;45:1610–2.
3. Ayman El-Nakeeb, Amir Fikry, Abd El-Hamed TM. Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer. Int J Surgery 2009;7:126–9.
4. O'Connor HJ, Kanduru C, Bhutta AS. Effect of Helicobacter pylori eradication on peptic ulcer healing. Postgrad Med J 1995;71:90-3.
5. Coghlan JG, Gilligan D, Humphries H, McKenna D, Dooley C, Sweeney E, et al. Campylobacter pylori and recurrence of duodenal ulcers-A 12-month follow-up study. Lancet 1987;2:1109-11.
6. Rokkas T, Karameris A, Mavrogeorgis A, Rallis E, Giannikos N. Eradication of Helicobacter pylori for the prevention of peptic ulcer re-bleeding. Gastrointest Endosc 1995;41:1-4.
7. Kuipers EJ, Thijs JC, Festen HP. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther 1995;9:59–69.
8. Gisbert JP, Pajares JM. Helicobacter pylori and bleeding peptic ulcer: what is the prevalence of the infection in patients with this complication? Scand J Gastroenterol 2003;38:2–9.
9. Hopkins RJ, Girardi LS, Turney EA. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996;110:1244-52.
10. Soll AH. Medical treatment of peptic ulcer disease. JAMA 1996;275:622-9.
11. Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:848–63.
12. Sekine H, Ohara S, Iijima K, Kato K. Recurrence rate of H. pylori after successful eradication and second eradication therapy after the initial failure of treatment. Nippon Rinsho 1999;57:116-20.
13. Metzger J, Styger S, Sieber C. Prevalence of Helicobacter infection in peptic ulcer perforation. Swiss Med 2001;133:99-103.
14. Enders KW, Lam YH, Joseph JY. Eradication of Helicobacter pylori prevents the recurrence of ulcers after simple closure of duodenal ulcer perforation. Ann Surg 2000;231:153-8.
15. Cheon JH, Kim N, Lee DH, Kim JM, Kim JS, Jung HC, et al. Long-term outcomes after Helicobacter pylori eradication with second-line, bismuth-containing quadruple therapy in Korea. Eur J Gastroenterol Hepatol 2006;18:515-9.
16. Hildebrand P, Bardhan P, Rossi L, Parvin S, Rahman A, Arefin MS, et al. Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults. Gastroenterology 2001;121:792-8.
17. Rollan A, Giancaspero R, Fuster F, Acevedo C, Figueroa C, Hola K, et al. The long-term reinfection rate and the course of duodenal ulcer disease after eradication of Helicobacter pylori in a developing country. Am J Gastroenterol 2000;95:50-6.
18. Kim N, Lim SH, Lee KH, Jung HC, Song IS, Kim CY. Helicobacter pylori reinfection rate and duodenal ulcer recurrence in Korea. J Clin Gastroenterol 1998;27:321-6.
19. Lai KC, Lan SK. The need for Helicobacter pylori eradication therapy in patients with peptic ulcer bleeding. HKMJ 1999;5:163-8.
20. Chey WD, Wong BC. American college of gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808-25.
21. Ryu KH, Yi SY, Na YJ, Baik SJ, Yoon SJ, Jung HS, et al. Reinfection rate and endoscopic changes after successful eradication of Helicobacter pylori. World J Gastroenterol 2010;16:251–5.
22. Yakoob J, Abid S, Jafri W. Low recurrence rate of Helicobacter infection in spite of high clarithromycin resistance. BMC Gastroenterol 2011;13:33.
23. Crofls TJ, Kenneth GMP, Robert JCS, Syndeny SCC, Arthur KCL. A randomized trial of non-operative treatment for perforated peptic ulcer. N Eng J Med 1989;320:970-3.
24. Laurence DR, Bennett PN. Clinical pharmacology. Churchill Livingstone, UK; 1990. p. 336-8.
25. Zittle TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today-indication, technique and outcome. Langerbacks Arch Sung 2000;85:84-96.
26. Marashall B, Warren JR. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancent 1983;1:1273-5.
27. Sebastian M, Chandran VP, Elashaal YI, Sim AJ. Helicobacter pylori infection in perforated peptic ulcer disease. Br J Surg 1995;82:360-2.
28. Sharma AK, Mittal S, Malvi SK. Association of Helicobacter pylori with peptic perforation in Chattisgarh region of India. Trop Gastroenterol 2000;21:42-3.
29. Ng EK, Chung SC, Sung JJ, Lam YH, Lee DW, Laa JY, et al. High prevalence of Helicobacter pylori infection in duodenal ulcer perforation not caused by non-steroidal anti-inflammatory drugs. Br J Surg 1996;83:1779-81.
30. Rahman M, Nazmul Ahsan HAM, Hussein D. Non-operative management of perforated peptic ulcer. Pak J Med Sci 2003;19:101-5.
31. Frezza M, Gorji N, Melato M. The histopathology of NSAIDs induce gastroduodenal damage correlation with Helicobacter pylori, ulcers, and hemorrhagic events. J Clin Pathol-Br Med J 2001;54:521-5.
32. Chan FK, Sung JJ, Suen R, Lee YT, Wu JC, Leung WK, et al. Dose eradication of Helicobacter pylori impair healing of non-steroidal anti-inflammatory drug-associated bleeding peptic ulcer? A prospective randomized study. Alment Pharmacol Ther 1998;12:1201-5.
33. Silra FM, Zaterka S, Eisig JN, Chehter EZ, Chinzon D, Laudanna AA. Factor affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor, tinidazole and clarithromycin in Brazillian patients with peptic ulcer. Rev Hosp Clin Fac Med Sao Paulo 2001;56:11-6.
34. Debongniue JC, Wibin E, Timmermans M, Mairesse J, Dekoninck X. Are perforated gastroduodenal ulcers related to Helicobacter pylori infection. Acta Gastroenterol Belg 1995;58:208-12.
35. US department of health and human services. Knowledge about the causes of peptic ulcer disease. Morbidity Mortality Weekly Report 1997;46:985-6.



How to Cite

RAJAB, H. K., and A. E. AL-SNAFI. “TWO YEARS FOLLOW UP AFTER ERADICATION THERAPY OF PEPTIC ULCER”. International Journal of Current Pharmaceutical Research, vol. 12, no. 2, Mar. 2020, pp. 28-31, doi:10.22159/ijcpr.2020v12i2.37482.



Original Article(s)