Helicobacter pylori eradication in the African setting, with special reference to reinfection and duodenal ulcer recurrence.

Louw, J. A.; Lucke, W; Jaskiewicz, K; Lastovica, Albert J.; Winter, Trevor A.; Marks, I. N.

doi:10.1136/gut.36.4.544

Cited by 50 publications

(27 citation statements)

References 14 publications

(1 reference statement)

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“…From a subsequent report of 147 patients, reported only in abstract form, Parsonnet estimated a reinfection rate of 8.8%/yr (1). Another report showed a reinfection rate of 4.2% in 47 Chilean patients after 1 yr of follow-up (21), whereas, in Africa, two of 27 patients (3.7%) were shown to be reinfected during a 2-yr period (37). In contrast, Goh et al reported no reinfections in 38 eradicated Southeast Asian patients during a 2-yr period (22).…”

Section: Discussionmentioning

confidence: 99%

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

Rollán¹,

Giancaspero²,

Fuster³

et al. 2000

Am J Gastroenterology

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OBJECTIVE:The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on the natural history of duodenal ulcer disease and the reinfection rate after treatment in a developing country. METHODS:A total of 111 H. pylori-infected patients with duodenal ulcer were treated with either omeprazole or famotidine plus two antibiotics for 2 wk. Those failed to respond to treatment were retreated with bismuth-based triple therapy. RESULTS:The radication rate was 76% (95% CI: 67-83%). Eventually, H. pylori was eradicated in 96 of the 111 patients (86%), who were followed-up clinically and endoscopically for a mean of 37.2 months. The cumulative reinfection rate after eradication (Kaplan-Meier) was 8% Ϯ 3% in yr 1, 11% Ϯ 4% in yr 2, and 13% Ϯ 4% in yr 3. Nine of the 12 reinfections occurred during yr 1. Recurrence of duodenal ulcer was detected in five patients (5.2%), all of them during yr 1 of follow-up. Histologically, gastritis scores (according to the Sydney system) improved significantly after eradication. CONCLUSIONS:In a high prevalence setting, H. pylori eradication and early reinfection rates after treatment are similar to rates observed in a low prevalence environment, whereas the late reinfection rate seems to be higher. However, up to 3 yr after treatment, most treated patients are free of H. pylori infection and/or ulcer activity. Even longer follow-up studies are necessary to determine whether specific retreatment policies are necessary to maintain long term eradication in developing countries. (Am J Gastroenterol 2000;95: 50 -56.

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Section: Discussionmentioning

confidence: 99%

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

Rollán¹,

Giancaspero²,

Fuster³

et al. 2000

Am J Gastroenterology

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“…In 28 of the patients, no endoscopic pathology was evident, but histology confirmed the presence of chronic active gastritis; 11 patients had duodenal ulcers and eight had gastric adenocarcinoma. Gastric biopsy specimens obtained from the antrum of all 47 patients and additionally from the fundus of five patients were cultured as described previously 21. Briefly, specimens were transported in a jar under microaerobic conditions (Oxoid Gas Generating BR38, Basingstoke, Hampshire, UK).…”

Section: Methodsmentioning

confidence: 99%

Heterogeneity in the Helicobacter pylori vacA and cagA genes: association with gastroduodenal disease in South Africa?

Kidd

Lastovica

Atherton

et al. 1999

Gut

Self Cite

124

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Background-Helicobacter pylori infection is universally associated with gastritis, but only sometimes with clinically significant disease. Candidate virulence markers seem to be useful in identifying the pathogenic infections in some populations. Aims-To investigate the association between putative virulence markers and disease in an African population. Methods-Fifty nine H pylori strains isolated from dyspeptic patients (11 with peptic ulceration, eight with gastric adenocarcinoma, and 28 with no pathology other than gastritis) were studied for diVerences in the genes vacA and cagA. Results-Forty seven (80%) of 59 strains had the vacA signal sequence genotype s1 (one s1a, 46 s1b) and 12 (20%) had subtype s2. vacA mid-region analysis revealed that 40 (68%) strains were vacA m1 and 19 (32%) were m2. All 14 strains from patients with peptic ulceration were vacA s1, in contrast to 23 (66%) of 35 strains from patients with gastritis alone (p<0.01). vacA s2 was found exclusively in patients with gastritis alone (p<0.01). All strains isolated from patients with gastric adenocarcinoma were s1b/m1 (p<0.005 versus gastritis alone). cagA was detectable in 56 (95%) of 59 isolates. Strains from patients with peptic ulceration (12/13 versus 19/30 with gastritis alone, p=0.05) had the shortest fragment length in the 3' region of cagA, while 4/10 strains from patients with gastric cancer had the longest fragment length in this region (p<0.02 versus gastritis alone). Conclusion-In this study, the vacA s1 genotype, and fragment length of the 3' region of cagA identified isolates associated with significant clinical disease. The vacA s1bm1 genotype seems to be strongly associated with gastric cancer. (Gut 1999;45:499-502)

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“…In Chile, re-infection occurred in 4.2% after 1 year 79 , with a treatment protocol that was 82% effective. In South Africa, a 7.3% re-infection ratio was found with a treatment protocol that was less than 60% effective 80 . It would not be unexpected if re-infection is more likely from an external source in countries with presently high infection rates, perhaps with the infection coming from a child.…”

Section: Risk Of Re-infectionmentioning

confidence: 99%

Epidemiology of Helicobacter pylori: acquisition, transmission, population prevalence and disease-to-infection ratio

Feldman

Eccersley

Hardie

1998

British Medical Bulletin

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Helicobacter pylori eradication in the African setting, with special reference to reinfection and duodenal ulcer recurrence.

Abstract: The aim ofthis study was Reinfection is uncommon. (Gut 1995; 36: 544-547)

Cited by 50 publications

References 14 publications

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

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

Heterogeneity in the Helicobacter pylori vacA and cagA genes: association with gastroduodenal disease in South Africa?

Epidemiology of Helicobacter pylori: acquisition, transmission, population prevalence and disease-to-infection ratio

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