Recurrence of Helicobacter pylori Infection and the Long-term Outcome of Peptic Ulcer After Successful Eradication in Japan

Abstract

Recurrence of peptic ulcer after successful eradication of Helicobacter pylori is closely associated with reinfection. The aim of this study was to examine the recurrence of peptic ulcer and reinfection with H. pylori after successful eradication. To eradicate H. pylori infection, patients with active peptic ulcer disease were assigned to two treatment groups depending on the year of their enrollment (AM group and OAMR group). Patients in the AM group received 400 mg of cimetidine twice per day, 300 mg of amoxicillin three times per day, and 250 mg of metronidazole three times per day for 2 weeks. Patients in the OAMR group received 20 mg of omeprazole once per day, 500 mg of amoxicillin granules three times per day, 250 mg of metronidazole three times per day, and 150 mg of roxithromycin twice per day for 1 week. After endoscopy verified ulcer scarring and successful eradication of H. pylori infection, study patients were followed up monthly and did not undergo acid-suppressive therapy. Endoscopy was performed at 6-month intervals for the 1st year. After the 1st year, follow-up endoscopies were performed annually. In total, 107 patients with peptic ulcer (duodenal ulcer [DU], 65; gastric ulcer [GU], 42) were followed up for a mean period of approximately 2 years. Recurrence of infection occurred in 10 (9.3%) of 107 patients (AM group, 9; OAMR group, 1) after 210 patient-years of follow-up; the recurrence rate was 4.8% per patient-year. Recurrence of H. pylori infection was significantly higher in the AM group (23.1%) than in the OAMR group (1.5%). H. pylori infection recurred in two patients 6 months after eradication therapy, in seven 1 year after, and in one 2 years after. Thereafter, no further cases of H. pylori recurrence were observed. During follow-up periods, seven cases of ulcer recurrence were observed (DU, 4; GU, 3). The rate of peptic ulcer recurrence within 2 years after eradication therapy was significantly higher than that after more than 2 years. Four cases of ulcer recurrence (DU, 3; GU, 1) also had recurrence of H. pylori infection. One recurrent case of DU without reinfection was associated with nonsteroidal anti-inflammatory drugs. The remaining two cases of GU recurred without H. pylori reinfection. In conclusion, peptic ulcer recurrence rarely occurred (3 [2.9%] of 103) in patients cured of H. pylori infection. Reinfection after apparent successful eradication was rarely noted when a powerful therapeutic regimen in eradication was used. Therefore, to eradicate H. pylori, a highly effective therapeutic regimen should always be used.

Long-term follow up Helicobacter Pylori reinfection rate after second-line treatment: bismuth-containing quadruple therapy versus moxifloxacin-based triple therapy

“…That is, the eradication rate of per protocol (PP) analysis decreased up to 75.9% in 2006 [9]. Some studies reported that the recurrence of H. pylori infection more frequently occurred in patients treated with a low efficacy regimen than in those treated with a high efficacy regimen, as a result of recrudescence of the organism after temporary suppression, not elimination [14,16,22,23]. In the previous studies, the PP eradication rates were reported at 77.2% for the 7- and 93.6% for the 14 day EBMT regimen [24], and 83.8% for the 7-, 82.6% for the 10- and 79.9% for the 14 day MEA regimen [25].…”

Triple Antimicrobial Therapy and Acid Suppression in Dogs with Chronic Vomiting and Gastric Helicobacter spp

“…4,5,9,38 Gastric Helicobacter spp have been identified in extragastric locations, such as the oral cavity (dental plaque, saliva, or gingival pockets), where they may be protected from antimicrobial therapy and could serve as a nidus for gastric recolonization and recrudescence of infection. 34,[39][40][41] Helicobacter pylori also can revert to a coccoid form after exposure to certain antibiotics. 34 It may not be possible to identify this form by routine laboratory techniques.…”

Reinfection after successful eradication of Helicobacter pylori: a 2‐year prospective study in Alaska Natives

“…[16][17][18][19][20][21][22] Intermediate rates of reinfection are found in the Mediterranean region and Japan, ranging from 1.5% to 16.7%. 15,[28][29][30][31][32][33][34] It is sometimes difficult to distinguish between reinfection, defined as the complete eradication of an H. pylori infection followed by the introduction of a new H. pylori infection and recrudescence, defined as the apparent clearance of an H. pylori infection due to suppression but not eradication of the organism, followed by a positive test for H. pylori. 35 In our study, positive cultures after reinfection were obtained from only two of 14 reinfected patients and RAPD-PCR testing showed similarity to the strains present prior to treatment.…”