Recurrence of Helicobacter pylori infection after several eradication therapies: long‐term follow‐up of 1000 patients

Abstract

SUMMARY AimTo study the incidence of Helicobacter pylori recurrence, its chronological aspects, and the variables that might influence it. MethodsA total of 1000 patients in whom H. pylori had been eradicated were prospectively studied. Therapies were classified as low and high efficacy regimens. Four to eight weeks after completion of therapy, 13 C-ureabreath-test was performed, and it was repeated yearly up to 5 years. In some patients, endoscopy with biopsies was also performed to confirm H. pylori eradication. ResultsA total of 1000 patients were included, giving 2744 patient-years of follow-up. Seventy-one H. pylori recurrences were observed (2.6% per patient-year). Probability of being H. pylori-negative at 1 year was 94.7%, and at 5 years 90.7%. In the multivariate analysis, low age (OR: 1.84; 95% CI: 1.04-3.26) and low efficacy therapies (OR: 2.5; 1.23-5.04) correlated with 1-year H. pylori recurrence. Differences were observed when Kaplan-Meier curves were compared depending on age and therapy regimen. ConclusionRisk of posteradication H. pylori recurrence is higher during the first year, which suggests that most recurrences during this period are recrudescence and not true reinfections. H. pylori recurrence is more frequent in younger patients and in those treated with low efficacy therapies, but is exceptional if high efficacy therapies are used, in which case posttherapy eradication can be safely confirmed at 4 weeks with 13 C-ureabreath-test.

Helicobacter pyloriDetection and Antimicrobial Susceptibility Testing

“…Age may also be considered. Generally speaking, younger patients are more likely to have been exposed to this drug, and they are also more likely to experience treatment failure (45,170) and, therefore, need culture and susceptibility testing. Conversely, older patients are more likely to have atrophy and other mucosal abnormalities, and therefore, histology is recommended.…”

Helicobacter pylori Recurrence in Developed and Developing Countries: Meta‐Analysis of 13C‐Urea Breath Test Follow‐Up after Eradication

“…However, this assumption is based on studies using heterogeneous testing methods and strategies, such as The aim of the present meta-analysis was to provide a more accurate assessment of H. pylori recurrence rates in developed and developing countries, and to deduce from these findings the relative roles of recrudescence and reinfection. To avoid the bias introduced by the different approaches used, we limited our database search to studies in adults in which the 13 CUBT was administered at completion of treatment, with a minimum follow-up of 12 months. We also performed a nested analysis of findings…”

“…Recrudescence (recolonization of the same strain) rather than reinfection (colonization with a new strain) is considered the more likely culprit in most cases [2]. However, this assumption is based on studies using heterogeneous testing methods and strategies, such as 13 C-urea breath test ( 13 CUBT), 14 C-urea breath test, stool antigen test, urease test, histology, or culture, and different times of testing after completion of treatment. Although most authorities believe a 4-week span is enough to confirm eradication [3], others advocate a span of 10-14 weeks [1].…”

“…To avoid the bias introduced by the different approaches used, we limited our database search to studies in adults in which the 13 CUBT was administered at completion of treatment, with a minimum follow-up of 12 months. We also performed a nested analysis of findings in patients reexamined at least 1 year after a negative follow-up 13 CUBT.…”

Reinfecção pelo Helicobacter pylori em pacientes brasileiros com úlcera péptica, em seguimento de 5 anos

“…O tipo de tratamento utilizado na erradicação da bactéria também pode ser um risco recorrência, porque esquemas de menor eficácia determinam mais frequentemente este fenômeno (41).…”