***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 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 One hundred twenty-two patients were r and omly assigned to three groups of treatment ( A , B , and C ) , with ( 1 ) ranitidine ( 300 mg q.d . for 6 weeks ) , ( 2 ) ranitidine ( 300 mg q.d . for 6 weeks ) with amoxicillin ( 500 mg t.i.d . ) and metronidazole ( 500 mg b.i.d . ) for the first 12 days , or ( 3 ) colloidal bismuth subcitrate ( 120 mg q.i.d . for 6 weeks ) with amoxicillin and metronidazole ( at same dosages as in the latter group ) . Six weeks after the beginning of treatment , an endoscopy showed that ulcers had healed in 49 of 52 patients ( 94.2 % ) from whom Helicobacter pylori had been eradicated and in 59 of 70 patients ( 84.3 % ) from whom it had not ( NS ) . The rates of H. pylori eradication in groups A , B , and C were zero , 47.5 % , and 86.8 % , respectively . At 6 , 12 , and 18 months , an endoscopy was repeated for monitoring ulcer recurrence and H. pylori status . Reinfection rates at 6 months were 42.1 % and 15.1 % in groups B and C , respectively ( P < .05 ) . At 18 months , ulcers recurred in 82.9 % ( 63 ) of 76 patients with noneradicated H. pylori infection , vs. 5.7 % ( 2 ) of 35 patients without H. pylori infection ( P < .001 ) . We conclude that colloidal bismuth subcitrate is more effective for eradication of H. pylori than ranitidine when given with amoxicillin plus metronidazole for the treatment of duodenal ulcer , as both early reinfection and ulcer recurrence are diminished We studied the effects of lansoprazole with or without amoxicillin on the quality of ulcer healing  in relation to eradication of Helicobacter pylori .  Ulcer healing rates for lansoprazole 30 mg q.d . alone ( group A ) were 100 % for duodenal ulcers ( DU ; n = 20 ) and 92 % for gastric ulcers ( GU ; n = 15 ) . The healing rates for lansoprazole 30 mg plus amoxicillin 1–2 g q.d . ( group B ) were 100 % for both DU ( n = 20 ) and GU ( n = 12 ) . Endoscopic findings after treatment showed that the red scar/white scar ratio in group A was 16/4 for DU and 12/1 for GU . The red scar/white scar ratio in group B was 4/16 for DU and 6/6 for GU . The numbers of H. pylori in gastric mucus did not change throughout the course of treatment in group A but decreased significantly , without H. pylori relapse , in group B. Changes in ammonia concentration in gastric juice , as well as serum gastrin and pepsinogen I and II levels , differed between group A and group B. Concomitant treatment with lansoprazole and high-dose amoxicillin  eradicated H. pylori and modified gastric secretory function , result ing in high- quality ulcer healing A r and omized , single-blind study was design ed to assess the effect of lansoprazole alone and lansoprazole plus amoxicillin on the healing and eradication rates in Helicobacter pylori-associated peptic ulcer disease . Seventy-nine patients with gastric ulcers and 54 patients with duodenal ulcers were r and omly assigned to two treatment groups . Group 1 received lansoprazole 30 mg daily for 8 weeks for gastric ulcers or 6 weeks for duodenal ulcers . Group 2 received the group 1 regimen plus amoxicillin 2 g daily for 2 weeks . Healing rates at 8 weeks for the gastric ulcer patients were 92 and 84 % in groups 1 and 2 , respectively ( p = not significant ) . Healing rates at 6 weeks for duodenal ulcers were 96 % in group 1 and 100 % in group 2 ( p = not significant ) . The eradication rates of H. pylori for gastric ulcer patients were 21 and 54 % in groups 1 and 2 , respectively ( p < 0.05 ) . The H. pylori eradication rates for duodenal ulcer patients were 5 and 73 % in groups 1 and 2 , respectively ( p < 0.001 ) . The H. pylori eradication rates in group 2 were significantly higher than in group 1 . Lansoprazole was effective for eradicating H. pylori in this study 60 patients with Helicobacter pylori ( Hp ) infection and duodenal ulcer ( DU ) were r and omized to received either : I ) Two weeks of bismuth subcitrate , metronidazole and amoxicillin ( TG ) or II ) Omeprazole for four weeks ( OG ) . Endoscopy and antral biopsies were done at entry and four weeks after treatment , control endoscopy was performed 2 - 4 - 8 and 12 weeks after inclusion in the trial . Healing was similar in both groups at two four weeks . At twelve weeks DU recurred in OG 65 % vs 13.36 % in TG and Hp infection was present . Our results showed that Hp eradication healed DU in a similar rate than Omeprazole providing further evidence of a causal link between Hp infection and duodenal ulcer One-third of adults experience pain or discomfort in the upper abdomen during a given year.1 Of these , 1/4 seek treatment , making dyspepsia the presenting complaint of 4 % of patients visiting primary care physicians.2,3 The optimal approach to uncomplicated dyspepsia in this setting remains controversial . Previous guidelines recommended initial antisecretory therapy , while reserving additional interventions for nonresponders.4 However , as evidence mounts to suggest that Helicobacter pylori eradication may relieve symptoms in many patients , 5 several consensus statements have suggested a “ test and treat ” approach for patients with simple uninvestigated dyspepsia.6–9 Specifically , patients younger than 45 with dyspepsia6,8 and without “ alarm ” symptoms ( bleeding , weight loss , dysphagia , anorexia , vomiting ) should be tested for H. pylori and , if positive , receive a 10to 14-day course of eradication therapy . If symptoms fail to improve with treatment , then diagnostic upper endoscopy should be performed . Despite evidence in support of this approach,5 several prospect i ve trials have cast uncertainty regarding the effectiveness of “ test- and -treat ” for dyspepsia.10–13 For example , 1 recent high- quality r and omized control trial suggested that the test and treat strategy applied to the general population may provide symptomatic relief for only 5 % of patients and makes no appreciable impact on quality of life.10 These results may be explained in part by 4 advances in our underst and ing of H. pylori eradication OBJECTIVE To investigate differences between omeprazole and Helicobacter pylori eradication in patients with duodenal ulcers refractory to H2-receptor antagonists and to compare the recurrence rates after the two treatments . DESIGN AND METHODS Forty-five patients with endoscopically proven duodenal ulcers refractory to H2-receptor antagonists and H. pylori infection were r and omly assigned to 8 weeks of treatment with omeprazole 40 mg/day or 4 weeks of treatment with colloidal bismuth subcitrate 480 mg/day plus metronidazole 750 mg/day and tetracycline 1000 mg/day from day 1 to day 14 . Patients were evaluated endoscopically and clinical ly at the end of treatment . Patients with healed ulcers were followed up for 1 year after cessation of the treatment . Endoscopy was performed at 3 and 12 months . RESULTS Ulcer healing occurred in 100 % ( 21/21 ) of patients on triple therapy and 70.5 % ( 12/17 ) of those treated with omeprazole alone ( P = 0.0123 ) . The relapse rate at the 3rd month was 11.7 % ( 2/17 ) in the triple therapy group and 60 % ( 6/10 ) in the omeprazole group ( P = 0.0248 ) . Of the patients followed to study endpoint ( relapse or endoscopy at 12 months ) three of 12 ( 25 % ) receiving triple therapy , compared to six of eight ( 75 % ) receiving omeprazole , relapsed ( P = 0.0648 ) . CONCLUSION These results show that triple therapy is more effective than omeprazole in the treatment 
    Output:
    
: H. pylori eradication therapy reduces the recurrence of peptic ulcer disease and is cost-effective