Treatment of symptom-free Helicobacter pylori-positive subjects

Aim: To investigate the need for treatment in symptom-free Helicobacter pylori-positive subjects. Design: Large-scale ongoing study of seropositive blood donors allocated to six treatment regimens. Methods: Specific immunoglobulin G antibodies to H. pylori were measured by enzyme-linked immunosorbent assay of serum from 1010 Bologna blood donors over 1 year. Out of 442 positive subjects, 298 were endoscoped with infection confirmed in 279. Six treatment regimens were applied, (1) placebo; (2) 240 mg colloidal bismuth subcitrate twice a day plus 500 mg tinidazole three times a day for 2 weeks; (3) 300 mg ranitidine each day for 4 weeks; (4) 120 mg colloidal bismuth subcitrate four times a day plus 500 mg amoxycillin four times a day for 7 days plus 500 mg tinidazole four times a day on days 5-7; (5) standard triple therapy for 2 weeks with amoxycillin; or (6) standard triple therapy for 2 weeks with tetracyclin. Endoscopy was repeated 4 weeks after the end of the treatment. Results: So far, repeat endoscopy has been performed in 162 subjects after the treatment was completed. Of these, 103 had been diagnosed as having active gastritis (determined histologically) and 59 a peptic ulcer (42 duodenal, 17 gastric). The H. pylori eradication rate by treatment group was 0% for group 1, 31% for group 2, 0% for group 3, 59% for group 4, 85% for group 5 and 94% for group 6. Continuation of study: The follow-up of these subjects will provide information on the need for treatment in symptom-free subjects.