***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The efficacy and safety of dual and triple therapies with a proton pump inhibitor and antibiotic(s ) for therapy of Helicobacter pylori-associated duodenal ulcer disease have been compared using results from independent studies using different methods and regimens , making interpretation difficult . In a large , double-blind , multicenter study conducted in the United States , we compared a triple therapy regimen with four dual therapy and one monotherapy regimens in the eradication of H. pylori and the prevention of ulcer recurrence . Methods : Patients with active duodenal ulcer disease or history of duodenal ulcer disease within the past year and H. pylori infection were r and omized to receive one of six 14-day treatment regimens : lansoprazole 30 mg , clarithromycin 500 mg , and amoxicillin 1 gm b.i.d . ; lansoprazole 30 mg b.i.d . and either clarithromycin 500 mg b.i.d . or t.i.d . ; lansoprazole 30 mg b.i.d . or t.i.d . with amoxicillin 1 gm t.i.d . ; or lansoprazole 30 mg t.i.d . alone . No additional acid suppression therapy followed eradication therapy . Primary efficacy endpoints were eradication of H. pylori and ulcer recurrence . Results : Of 396 patients enrolled in the study , 352 met the entry criteria for duodenal ulcer status and H. pylori positivity . At 4–6 wk after the end of therapy , H. pylori was eradicated from 94 % ( 44 of 47 ) of patients receiving lansoprazole , clarithromycin , and amoxicillin triple therapy , 77 % ( 39 of 51 ) of those receiving lansoprazole t.i.d./amoxicillin t.i.d . , 75 % ( 36 of 48 ) of those receiving lansoprazole b.i.d./clarithromycin t.i.d . , 57 % ( 28 of 49 ) of those receiving lansoprazole b.i.d./clarithromycin b.i.d . , 53 % ( 26 of 49 ) of those receiving lansoprazole b.i.d./amoxicillin t.i.d . , and 2 % ( 1 of 53 ) of those receiving lansoprazole monotherapy ( p≤ 0.05 , triple therapy vs each dual therapy and each dual therapy vs monotherapy ) . Of those patients who were documented as free of ulcer at 4–6 wk after treatment , ulcers recurred within 6 months in 7 % of patients receiving triple therapy , as compared with 13–23 % of patients receiving dual therapy , and 69 % of patients receiving lansoprazole monotherapy . Patients who were H. pylori negative at 4–6 wk after treatment were less likely to have an ulcer recurrence than were patients who were H. pylori positive ( 11 % [ 10 of 95 ] vs 47 % [ 20 of 43 ] , respectively , across treatment groups ) . For triple therapy and dual therapy , a similar proportion of patients reported a drug-related adverse event ( 23%vs 17–33 % , respectively ) . Conclusions : In patients with active or a recent history of duodenal ulcer , a 14-day course of lansoprazole-based triple therapy without additional acid suppression therapy is highly effective in the eradication of H. pylori and in preventing ulcer recurrence . Among the dual therapies , higher eradication rates occurred when lansoprazole ( with amoxicillin ) or clarithromycin ( with lansoprazole ) was administered t.i.d . vsb.i.d . , but the rates were still significantly lower than with lansoprazole triple therapy with all three drugs administered b.i.d OBJECTIVES : To determine the efficacy of once-daily esomeprazole plus antibiotics for eradication of Helicobacter pylori , to assess the effect of antibiotic resistance on eradication rate , and to define the rate of emergent resistance . METHODS : Three separate r and omized trials were performed in H. pylori – positive patients with a duodenal ulcer or history of documented duodenal ulcer within 5 yrs : 1 ) esomeprazole ( 40 mg once daily ) , amoxicillin ( 1 g b.i.d . ) , and clarithromycin ( 500 mg b.i.d . ; this combination will be referred to as EAC ) versus esomeprazole ( 40 mg once daily ) plus clarithromycin ( 500 mg twice daily ; this combination will be referred to as EC ) ; 2 ) EAC versus esomeprazole ( 40 mg once daily ; E ) ; and 3 ) EC versus E. Therapy was given for 10 days . Endoscopy and biopsies for CLOtest , histology , and culture with susceptibility testing were done at baseline and 4 wk after completion of therapy . RESULTS : Per- protocol and intent-to-treat eradication rates , respectively , were as follows . For EAC versus EC in study 1 ( N = 448 ) , 84 versus 55 % and 77 versus 52 % ( p < 0.001 ) ; for EAC versus E in study 2 ( N = 98 ) , 85 versus 5 % and 78 versus 4 % ( p < 0.001 ) ; for EC versus E in study 3 ( N = 66 ) , 50 % versus 0 and 46 % versus 0 ( p < 0.05 ) . The 15 % of patients in the combined studies with baseline clarithromycin resistance had significantly lower rates of eradication than those with susceptible strains ( EAC : 45 vs. 89 % ; EC : 13 vs. 61 % ) . Emergent resistance was less common after treatment with EAC [ 2/6 ( 33 % ) ] than with EC ( 23/27 [ 85 % ] ) . CONCLUSIONS : Ten-day triple therapy with once-daily esomeprazole plus twice-daily amoxicillin and clarithromycin achieves an eradication rate virtually identical to that of the twice-daily proton pump inhibitor – based triple therapies . Baseline clarithromycin resistance , present in 15 % of patients , predicts a markedly decreased rate . Use of an amoxicillin-containing regimen may decrease emergence of clarithromycin resistance This study compared high dose ranitidine versus low dose omeprazole with antibiotics for the eradication of H pylori .  80 patients ( mean age 48 years , range 18 - 75 ) who had H pylori infection were r and omised in an investigator-blind manner to either a two-week regime of omeprazole 20 mg daily , amoxycillin 500 mg tid and metronidazole 400 mg tid ( OAM ) , or ranitidine 600 mg bd , amoxycillin 500 mg tid and metronidazole 400 mg tid ( RAM ) , or omeprazole 20 mg daily and clarithromycin 500 mg tid ( OC ) , or omeprazole 20 mg daily and placebo ( OP ) . H pylori was eradicated in 6 of 19 patients in the OAM group ( 32 % ) ; 8 of 18 in the RAM group ( 44 % ) , 4 of 15 in the OC group ( 27 % ) ; none of 18 in the OP group ( 0 % ) . [ < P0.005 for OAM , RAM , OC vs OP ; P = N.S. between OAM , RAM , OC ] . Overall metronidazole resistance was unexpectedly high at 58 % . Eradication rates in metronidazole sensitive patients were 71 % ( 5/7 ) and 100 % ( 3/3 ) for OAM and RAM respectively . In conclusion , H pylori eradication rates using high dose ranitidine plus amoxycillin and metronidazole may be similar to that of low dose omeprazole in combination with the same antibiotics for omeprazole with clarithromycin .  Overall eradication rates were low due to a high incidence of metronidazole resistance but were higher in metronidazole-sensitive patients . Even high dose ranitidine with two antibiotics achieves a relatively low eradication rate . These metronidazole-based regimens can not be recommended in areas with a high incidence of metronidazole resistance Are meta-analyses the brave new world , or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable ? Negative trials are often unreported , and hence can be missed by meta-analysts . And how much heterogeneity between trials is acceptable ? A recent major criticism is that large r and omised trials do not always agree with a prior meta- analysis . Neither individual trials nor meta-analyses , reporting as they do on population effects , tell how to treat the individual patient . Here we take a more rounded approach to meta-analyses , arguing that their strengths outweigh their weaknesses , although the latter must not be brushed aside This study attempted to determine the efficacy of lansoprazole plus clarithromycin therapy in the eradication of Helicobacter pylori in gastric ulcer patients . The influence of H. pylori eradication on healing and relapse of ulcers was also studied . Thirty-nine patients received either lansoprazole 30 mg daily for 8 weeks ( group 1 ) or clarithromycin 200 mg twice daily for 2 weeks and lansoprazole 30 mg daily for 8 weeks ( group 2 ) . Before treatment , H. pylori status was evaluated by a rapid urease test and histologic examination . H. pylori clearance and eradication were evaluated by a rapid urease test , polymerase chain reaction , and a [13C]urea breath test . Clearance of H. pylori was 0 % in group 1 and was 33 % in group 2 . Eradication of H. pylori was 0 % in group 1 and 21 % in group 2 . Although all five ulcers were healed in patients with H. pylori eradication , ulcers were not healed in the five patients without eradication . Relapse of ulcer was observed in three patients in whom eradication had failed . In this study , for H. pylori- positive gastric ulcer patients , better results were obtained when lansoprazole plus clarithromycin therapy was used , and H. pylori eradication was achieved BACKGROUND / AIMS Reduction of gastric acid secretion by maintenance treatment with antisecretory agents and eradication of H. pylori by antibiotics constitute the most effective therapeutic options in preventing duodenal ulcer relapse . The aim of this study was to compare the effect of a 12-month low-dose lansoprazole maintenance treatment with H. pylori eradication on the rate of ulcer relapse in H. pylori-positive duodenal ulcer patients . METHODOLOGY After a healing phase with lansoprazole 30 mg/die or lansoprazole 30 - 60 mg/die plus antibiotics ( amoxycillin , tinidazole and colloidal bismuth subcitrate ) , 84 patients with healed duodenal ulcer entered the follow-up phase . Thirty-eight patients with persistent H. pylori infection received lansoprazole 15 mg at bedtime , whereas 46 in whom H. pylori was eradicated during the acute phase received no active therapy during the 12-month follow-up . The two groups were well balanced concerning all demographic characteristics . Clinical controls were performed every 3 months or sooner in the event of symptomatic relapse . RESULTS In terms of per protocol analysis , the overall rate of ulcer relapse at 6 months was 5.5 % ( 2/36 ) in the maintenance group and 0 ( 0/42 ) in the antibiotic group . The corresponding figures at 12 months were 20.5 % ( 7/34 ) and 5.7 % ( 2/35 ) , respectively ( p : ns , 95 % CI for the difference -0.30 + 0.02 ) . On intent to treat analysis , the rate of ulcer relapse at 6 months was 5.2 % ( 2/38 ) in the first group and 0 % ( 0/46 ) in the second group : at 12 months the corresponding figures were 19.4 % ( 7/36 ) and 4.3 % ( 2/46 ) , respectively ( p=0.06 ; CI 95 % : + 0.016 + 0.28 ) . No significant side effects were observed during long-term maintenance with lansoprazole . CONCLUSIONS Continuous maintenance with low-dose lansoprazole may constitute a valuable alternative to H. pylori eradication for the prevention of relapse and complications in duodenal ulcer patients not suitable for , or who have failed , H. pylori eradication Conclusions  Eradication treatment  for H. pylori-positive gastric or duodenal ulcer is sufficient , with no need to follow it with anti-secretory medication . Cure of the infection reduces ulcer relapses in patients who did not use NSAIDs or ASA.(95  % CI , 73 - 100 % ) and 75 % ( 95 % CI 
    Output:
    
None of the trials reported proportion of people with gastric ulcer not healed after initial therapy between H.pylori eradication therapy and no active treatment or the proportion of people with recurrent gastric ulcer or peptic ulcers during maintenance therapy between H.pylori eradication therapy and ulcer healing drug therapy .
AUTHORS ' CONCLUSIONS Adding a one to two-week course of H. pylori eradication therapy is an effective treatment for people with H. pylori-positive duodenal ulcer when compared to ulcer healing drugs alone and no treatment .
H. pylori eradication therapy is also effective in preventing recurrence of duodenal and gastric ulcer compared to no treatment .
There is currently no evidence that H. pylori eradication therapy is an effective treatment in people with gastric ulcer or that it is effective in preventing recurrence of duodenal ulcer compared to ulcer healing drug .