Duodenal Ulcer and Eradication ofHelicobacter pyloriin a Developing Country An 18-Month Follow-up Study

Abstract

Forty-eight patients with endoscopically proven duodenal ulcer (DU) and Helicobacter pylori infection detected by 14C-urea breath test (BT) were assigned to 5 days of treatment with furazolidone, metronidazole, and amoxicillin in addition to eventual classical anti-ulcer agents if necessary. Clinical evaluation and BT were repeated at 2, 6, and 18 months after therapy to determine H. pylori eradication or reinfection. Endoscopy was also repeated at 6 and 18 months after treatment to detect DU relapse. In 29 (60%) patients H. pylori had been eradicated at 2 months after therapy, and in 19 (40%) infection persisted. After successful eradication, 6 of 29 (20.7%) were reinfected. All 24 patients who were negative at the 18-month evaluation were asymptomatic, free of anti-ulcer drugs, and with healed ulcers, whereas among the 19 positive patients followed up, 11 (57%) continued to be symptomatic and still using anti-ulcer agents (p less than 0.010), and 10 (53%) showed active ulcers at endoscopy (p less than 0.010). H. pylori eradication is clearly followed by long-term remission of DU. Reinfection may be an additional problem in treating DU patients in developing countries.

The long-term reinfection rate and the course of duodenal ulcer disease after eradication of Helicobacter pylori in a developing country

“…Reported reinfection rates range from 0 (22) to 100% (18). Coelho et al, from Brazil, reported that six of 29 eradicated patients (20%) became reinfected after 18 months of follow-up (20). From a subsequent report of 147 patients, reported only in abstract form, Parsonnet estimated a reinfection rate of 8.8%/yr (1).…”

The burden of Helicobacter pylori infection in Europe

“…Reinfection in adults in developed countries is quite rare but has been found in 20% of patients in Brazil within 18 months of eradication. 9 This finding has clear clinical implications for the value of treating H. pylori infection in developed vs.…”

Aspectos epidemiológicos do Helicobacter pylori na infância e adolescência

“…Estudos clínicos e moleculares, porém, indicam que a recrudescência da infecção e a transmissão iatrogênica são responsáveis por grande parte dos casos de soroconversão pós-tratamento, particularmente quando ocorre nos primeiros 12 meses após a erradicação do agente. 19,24,45,125,134,145 Nos países em desenvolvimento, a reinfecção pós-sucesso terapêutico é freqüente (aproximadamente 50% dos casos), atingindo índices de até 100% dos casos ao ano, como se pode observar no Peru. 120 Entretanto, nos países industrializados, a taxa de reinfecção varia entre 0,6% a 4,7% ao ano.…”