Five‐year follow‐up study after Helicobacter pylori eradication: Reinfection and peptic ulcer status

Abstract

OBJECTIVE: To investigate the prevalence of peptic ulcers and Helicobactor pylori reinfection 5 years after H. pylori eradication. METHODS: One thousand and six adults were randomly sampled from the general population in a high‐incidence region of gastric cancer. Of these, 552 subjects were confirmed to be H. pylori‐positive by using both the rapid urease test and the Warthin−Starry stain. All H. pylori‐positive subjects were randomly divided into two groups: (i) the eradication group, who received 1 week of omeprazole‐based triple therapy; and (ii) the control group, who received placebo tablets. Four weeks after the cessation of treatment, 13C‐urea breath tests demonstrated that H. pylori had been successfully eradicated in 88.9% of patients in the eradication group, whereas 96.4% of patients remained H. pylori positive in the control group. Subjects in both groups were followed up using endoscopy at the end of the first and fifth year after treatment. The H. pylori infection status was determined by using the rapid urease test and Warthin−Starry staining. RESULTS: The response rates to endoscopy at the end of the first and fifth year were 89.3 and 83.11%, respectively. The prevalence of peptic ulcers in the eradication group and control group were 9.87 and 7.61% before treatment, 3.70 and 12.58% 1 year after treatment (P < 0.05), and 5.86 and 14.93% 5 years after treatment (P < 0.05), respectively. The recurrence rates of peptic ulcers in the eradication group and the control group were 3.70 and 38.10% 1 year after treatment, and 14.81 and 42.86% 5 years after treatment, respectively. The rates of H. pylori infection 1 and 5 years after treatment in the eradication group were 13.58, and 19.82%, respectively. In the control group, the rates of H. pylori infection were 91.97 and 83.26% 1 and 5 years after treatment, respectively. CONCLUSIONS: The prevalence of peptic ulcers decreased significantly after the eradication of H. pylori. The reinfection rate after H. pylori eradication was 4−5% per year. Helicobacter pylori infection status remained constant in almost 85% of cases.

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

“…3 for the developed countries [4,6,7,[10][11][12][13], and in Fig. 4 for the developing countries [16,17,19,20]. The nested meta-analysis revealed an annual recurrence rate of 1.45% in the developed and 12% in the developing countries.…”

Long‐term Follow up of Helicobacter pylori IgG Serology After Eradication and Reinfection Rate of H. pylori in South Korea

“…Most recurrent H. pylori infections were defined as recrudescence rather than reinfection. However, high recurrence rates have been reported in Asia, ranging from 4.3 to 20.7%, in countries with a high prevalence of H. pylori infection [13–15]. Although the precise mechanism of transmission is poorly understood, socioeconomic status is presumed to play an important role in H. pylori infection [16,17].…”

Review article: ‘true’ re‐infection of Helicobacter pylori after successful eradication – worldwide annual rates, risk factors and clinical implications

“…In this review, ‘true’ re‐infection is defined as the situation where tests for H. pylori infection, which were negative for 12 months after eradication treatment, become positive again at a later stage, based on both clinical and molecular evidence previously reported (Table 1). 21–62 Although this definition is still arbitrary and distinct from the above mentioned definition based on molecular techniques, this term provides a more practical and feasible clinical and epidemiological connotation. Thus, this definition is widely recommended and used by many investigators 25, 31, 37, 47, 50 .…”

“…A total of 36 studies in which annual rates of ‘true’ re‐infection can be adapted or calculated were identified 21–56 . Of these studies, two were published as a letter and one was reported in a review 24, 28, 46 .…”

“…Of these studies, two were published as a letter and one was reported in a review 24, 28, 46 . Therefore, data from 33 original articles (Table 1) were considered reliable and adequate and were included in the further review on the worldwide ‘true’ re‐infection rates of H. pylori after eradication in adults and in children and the potential predictive significance of clinical factors in ‘true’ re‐infection 21–23, 25–27, 29–45, 47–56 …”