If the organism is successfully eradicated, the 12-month rate of ulcer recurrence is approximately 6 percent, compared with 67 percent if eradication is unsuccessful. Recommended first-line eradication therapies include proton pump inhibitors such as omeprazole and lansoprazole to relieve symptoms and promote ulcer healing. Two current regimens combine a proton pump inhibitor with clarithromycin and metronidazole or clarithromycin and amoxicillin. In both regimens, medications are given twice daily for 10 to 14 days and have efficacy rates of approximately 90 percent. The only significant side effects reported are taste disturbances and diarrhea.
Alternative therapies combine proton pump inhibitors with bismuth, metronidazole and tetracycline.
Serologic tests for H. pylori remain positive after successful eradication, but new breath tests can confirm eradication based on detection of carbon dioxide metabolized from labeled urea. Up to one third of elderly patients living in the community report involuntary loss of urine with consequent social and hygiene problems. Many conditions can cause or exacerbate urinary incontinence, and the acronym DRIP is suggested to guide investigations. The clinical history, examination and initial tests are directed toward identifying one of the three basic mechanisms of incontinence. In cases of overactive detrusor muscle, typical symptoms include frequency, nocturia, urgency, urge incontinence and nocturnal enuresis.