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Editor,—Apart from validating the reversibility of the pathogenic processes mediated by Helicobacter pylori in the causation of duodenal ulcer, the study by Lamet al (Gut1997;41:43–8) also served as a reminder that, even in H pylori associated ulcer disease, other mechanisms have a reversible aetiopathogenic role, exemplified by the spontaneous remission documented through the use of placebo. There is a danger of underestimating these unknown mechanisms if, as the authors unfortunately did, like is not compared with like, an example being the reporting of the 100% 12 week healing rate achieved through adherence to the antibiotic protocol as a comparison with the 53.1% healing rate for placebo on the intention to treat analysis in the Results section (page 45). Strictly speaking, the former should have been compared with patients on placebo in the protocol group, yielding a comparison of 100%v 63.4%. Finally, the penultimate line in table 3, dealing with the healing rate for H pylori positive patients allocated to placebo, did not make sense. These are minor criticisms in an otherwise good paper.
Editor,—We are pleased that Dr Jolobe hit the nail on its head by pointing out that placebo can heal duodenal ulcers. In fact, placebo has been shown to heal up to 70% of duodenal ulcers.1-1 Factors other than eradication ofH pylori are clearly operating in the pathophysiology of ulcer healing. Our study does help to reassure us that as long as we can get rid of H pylori, whether temporarily or permanently, duodenal ulcers heal.
Dr Jolobe’s two criticisms are valid. The first one represents a slip of the pen when writing the text, as the comparisons were done head for head, tail for tail in table 2. The second is a slip in proof reading, as there should be an absolute number, 14, in front of the percentage 37.8 in table 3. Our apologies.
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