Effect of treatment of Helicobacter pylori Infection on the Long-term Recurrence of Gastric

or Duodenal Ulcer
















Jorge Serrano
3/6/2014
(714) 714-7744
Jserrano@csuf.fullerton.edu






Reoccurrence of Gastric or Duodenal Ulcer


The wide spread epidemic of peptic ulcers are mainly due to the infection of a highly
resistant bacterium called Helicobacter pylori. Helicobacter pylori cause peptic ulcers by
damaging the mucosal lining of either the gastric or duodenum (Graham et al,. 1992). By
stripping off this mucosal coat, it allows stomach acids to become susceptible to sensitive
epithelial cells (Graham et al,. 1992). The damaging of epithelial cells is what causes an
intense burning sensation and even acute blood loss. Although current treatments are able
to treat this disease, frequent reoccurrence leads to its ineffectiveness. Our objective is to
conduct a study at a Veterans Hospital by comparing the effects of treating Helicobacter
pylori and the reoccurrence of gastric or duodenal ulcer. This project will obtain empirical
relationships between the use of different antiulcer treatments and the reoccurrence of
gastric and duodenal ulcers in patients. Our hypothesis is to relate the eradication of
Helicobacter pylori due to the intervention of specific treatments to diminish the
reoccurrence of gastric or duodenal ulcers
Project Objective

The overall objective of this research is to perform unbiased experiments to
determine the effectiveness of treating gastric or duodenal ulcer by eradicating
Helicobacter pylori. The treatment will follow the effects of two antiulcer treatments
indicated as ranitidine and ranitidine plus triple therapy. Coupled with advanced
endoscopy and molecular screening techniques will identify the presence of peptic ulcers
and Helicobacter pylori. While statistical analysis will determine significance of whether
treatment with ranitidine or ranitidine reoccurred less frequently. These objectives are
essential in gaining reliable insight on the treatment of Helicobacter pylori as we use the
combination of control groups and single blind studies.
Methodology

Subjects eligible to undergo this research will be selected from a Veterans Affairs
Hospital. Through random selection, patients experiencing gastric and duodenal ulcers will
be subjected to two different types of treatment. Patients will be treated with ranitidine or
ranitidine plus triple therapy. The triple therapy consists of a combination of antibacterial
medications such as tetracycline, metronidazole, and bismuth subsalicylate. Those patients
that fully healed will only be able to participate in our follow up study.
Patients chosen for our research study will not receive additional treatments after
the allotted 18-week period or after their ulcer has been completely healed. Follow up
appointments with patients will be conducted every three months for the duration of two
years. These meetings will assess the reoccurrence of gastric or duodenal ulcers after
treatment.
Patient Screening

The majority of the data will not only represent reoccurrences of peptic ulcers but
also involve information about our patients. Randomly selecting patients will allow a large
and diverse sample group for further analysis. A chart detailing patient demographics and
clinical characteristics will help compare the treatment of gastric and duodenal ulcers
along with the influences of external factors. Patients will be characterized by age, gender,
ethnicity, recent NSAID use, alcohol consumption and smoking consumption. This will give
our research team the opportunity to test leading hypothesis on the regeneration of peptic
ulcers. Most notably it will test the hypothesis that males who drink and smoke have
greater chances of reforming peptic ulcers. The attention to patient history will provide
additional clues to the development of peptic ulcers due to external factors and how it will
influence the reoccurrence.
Biochemical and Molecular Screening of Gastric or Duodenal Ulcers

The presence of Helicobacter pylori in patients requires the use of biochemical
experiments for identification. Where the use of a C-urea breath test identifies Helicobacter
pylori unique molecular properties through immunosobent assay (ELISA), culture plates
and histological examinations (Graham et al., 1992). The negative presence of Helicobacter
pylori will rely on the negative results of all three tests (Graham et al., 1992).
Endoscopy Screening of Screening of Gastric or Duodenal Ulcers
Gastric and Duodenal ulcers will be identified through endoscopy method, a minor
medical procedure involving a video-endoscope. This will identify if a circumscribed brake
has occurred in the duodenal or gastric mucosal layer (Graham et al., 1992). Positive
results will indicate mucosal breaks bigger than 5mm in diameter.
Statistical Analysis on the reoccurrence of Gastric and Duodenal Ulcers
Data gathered by the following tests will be calculated through statistical programs
called lifetables. These lifetables will present comparisons between patients with ulcer
recurrences due to treatments of ranitidine alone or ranitidine with triple therapy. This
will determine if subjects under the treatments of ranitidine plus triple therapy will result
in lower reoccurrences then with treatments of ranitidine alone. These results could help
dispute hypothesis generated from previous studies (Graham et all 1992,247).
Previous studies
As stated before, chronic peptic ulcers have been characterized as a reoccurring
disease even after undergoing intensive treatments. Although peptic ulcers seem to retard
during antiulcer therapy, reoccurrences increased after treatments have stopped (Graham
et all 1992,247). For this reason it is thought that previous attempts to treat peptic ulcers
did not affect the natural history of the disease (Graham et all 1992,247). Previous studies
suggest eradication of Helicobacter pylori entirely will only affect the nature of the disease
(Graham et al., 1992). Our research will look to eradicate Helicobacter pylori completely
through the use of two antiulcer treatments. The effectiveness of these two drugs will
provide pivotal information to physicians around the world to better treat this disease.
Single Blinded Study
Although previous studies have provided the groundwork for peptic ulcer research
their experimental design and data collection have been plagued with bias. By not
incorporating random sampling or single blinding trials, the data that supports their thesis
can be looked at as being inaccurate. Our research entails, procedures to be highly
randomized and eliminate the possibility of bias. This will be accomplished by subjecting
endoscopy physicians in single blind trials to assess the presence of gastric or duodenal
ulcers. Unadulterated data gathered from these assessments will allow our research team
to accurately evaluate patterns.
Duodenal and Peptic Ulcer Impact
Previous attempts to combat this disease were unsuccessful as peptic ulcers
proceeded after treatment stopped. My research will test the hypothesis that the total
eradication of Helicobacter pylori will result in a substantial decrease in reoccurrences of
peptic ulcers. Considering that Helicobacter pylori are characterized as being prevalent in
most developed countries, it poses a serious health threat to the United States. My proposal
entails an unbiased experimental scheme to determine the effects of Helicobacter pylori on
gastric and duodenal ulcers. This will help shed light on previous research studies as well
as provide evidence on the effectiveness of antiulcer treatments.





















References Cited

Federico, A., Gerarda, A., Miranda, A., Loguercio, C., & Ronano, M. (2014,
January 21). Result Filters. National Center for Biotechnology Information.
Retrieved March 6, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/245

Gonzales, G., Perez, P., & Garza, M. (2014, February 14). A review of
Helicobacter pylori diagnosis, treatment, and methods to detect eradication.
Baishideng Publish group. Retrieved March 2, 2014, from
http://www.wjgnet.com/1007-9327/full/v20/i6/1438.htm

Graham, D., Lew, G., Klein, P., Evans, D., Evans, D., Saeed, Z., et al.
(1992). Effects of Treatment of Helicobacter pylori Infection on the Long term
Recurrence of Gastric or Duodenal Ulcer. Writing in the Sciences, 1, 247-250.













Biographical Sketch
My field of emphasis is molecular biology, which incorporates many fields of biology,
such as genetics, chemistry, cellular interactions, human physiology and microorganisms.
Relevant course that I have taken is an upper division microbiology course that encompasses
aspects of virology, bacteria. protists and fungi. This has given me proficient skills in culturing,
staining, and performing metabolic test to assist in the identification of specific microorganisms.
My main research interests are sequencing and identifying key genes dealing with key human
physiology importance. Currently I am pursing my undergraduate in the emphasis of molecular
biology and I am expected to graduate at the end of the 2014 spring semester.