High rates of recurrence and of transient reinfections of Helicobacter pylori in a population with high prevalence of infection

Leal-Herrera, Yelda Aurora; Torres, Javier; Monath, Thomas P.; Ramos, Irma; Gómez, Alejandro; Garza, Armando Madrazo-de la; Dehesa-Violante, Margarita; Muñoz, Onofre

doi:10.1111/j.1572-0241.2003.07708.x

Cited by 41 publications

(26 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Resultsmentioning

confidence: 96%

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

Niv

Hazazi

2008

Helicobacter

View full text Add to dashboard Cite

Objective: Recurrence of Helicobacter pylori infection after eradication is rare in developed countries and more frequent in developing countries. Most recurrent cases are attributed to recrudescence (recolonization of the same strain within 12 months) rather than to reinfection (colonization with a new strain after more than 12 months). The aim of the study was to analyze recurrence rates in developed and developing countries and to deduce the relative roles of recrudescence and reinfection. Methods: The PubMed database was searched up to January 31, 2007 using the keywords " Helicobacter pylori " or " H. pylori " and "recurrence" or "recrudescence," or "reinfection." Only prospective case studies in adults that used the 13 C-urea breath test ( 13 CUBT) were included. Meta-analyses were performed with STATDIRECT Statistical software, version 2.6.1, StatsDirect Ltd, Chesire, UK. Results: The literature search yielded 10 studies of H. pylori recurrence in developed countries (3014 patients followed for 24-60 months) and 7 studies in developing countries (2071 patients followed for 12-60 months). The calculated annual recurrence rates were 2.67% and 13.00%, respectively. Nested metaanalysis of cases with a longer follow-up after eradication revealed an annual recurrence rate of 1.45% (RR 0.54) in developed countries and 12.00% (RR 0.92) in developing countries. Conclusions: The similarity of the annual recurrence rates during the first year after eradication and the annual recurrence rates in the second year after successful eradication in developing countries supports reinfection as the main cause in the second period. Therefore, a different approach for followup of H. pylori eradication may be needed between developed and developing countries. KeywordsHelicobacter pylori , eradication, recurrence, recrudescence, reinfection. Recurrence of Helicobacter pylori ( H. pylori ) infection after successful eradication is rare in developed countries and more frequent in developing countries [1]. 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 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 Reprint requests to

show abstract

Section: Resultsmentioning

confidence: 96%

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

Niv

Hazazi

2008

Helicobacter

View full text Add to dashboard Cite

show abstract

“…In both experimental (10) and accidental (12,13) exposures of humans to the organism, H. pylori detection and associated inflammation were followed by spontaneous clearance within 14 days in a subset of subjects; in others the infections persisted. Epidemiological studies have also shown evidence of transient H. pylori infections in young children (17) and patients previously cured of H. pylori (9). In addition to humans, transient infections have also been reported in previously cured macaques (23).…”

Section: Discussionmentioning

confidence: 93%

Significance of Transiently Positive Enzyme-Linked Immunosorbent Assay Results in Detection of Helicobacter pylori in Stool Samples from Children

et al. 2005

View full text Add to dashboard Cite

In young children, the significance of stool samples transiently positive for Helicobacter pylori antigen is unknown. As part of a larger prospective study on enteric infections, stool samples were obtained from 323 children at two time points 3 months apart and tested for H. pylori antigen using a commercially available enzymelinked immunosorbent assay (ELISA) test. Seminested PCR for a Helicobacter-specific 16S rRNA gene was performed on all 26 pairs reverting from positive to negative ( Helicobacter pylori chronically colonizes the human stomach. Little is know about the transmission of H. pylori, although most cases appear to be acquired in childhood. Because the date of acquisition of H. pylori is rarely known, most clinical and epidemiological studies have focused on chronic infection. Some data do indicate, however, that transient H. pylori infection can occur. For example, among patients who have been infected experimentally (10, 14) or endoscopically (12), the majority with reported follow-up had spontaneous resolution of infection. In children, transiently positive breath, serum, and stool antigen tests for H. pylori infections have been reported (17,21,24). The validity of these findings, however, has been uncertain due to the lack of standardization of these diagnostic tests in young children.In a cohort study designed to identify risk factors for H. pylori transmission, we collected two sequential stool samples from 323 children. Among these children, 26 reversions (i.e., transient stool positives) were discovered. We conducted a study to determine whether these transiently positive stool samples represent true transient infections or false-positive stool antigen tests. MATERIALS AND METHODSStudy participants. As part of a large cohort study on transmission of enteric infections (20), households with an index case of gastroenteritis, with at least one additional participating member, were recruited through cooperating community health care settings as well as community outreach. An index case was defined as a case of diarrhea with or without vomiting characterized by at least five stools per day and lasting no more than 14 days. There was no age restriction for index cases. Episodes of possible noninfectious etiology, such as pregnancy, poisoning, or drug effects, were excluded. This source population is predominately lowincome and Hispanic, including a large percentage of foreign-born people. A brief telephone interview confirming study eligibility was followed by a home visit within 14 days of the index case of gastroenteritis reported in the home. Visits were conducted by trained research staff fluent in the primary language of the home. After providing informed consent, a structured questionnaire was administered regarding household demographics, socioeconomic markers, risk factors for H. pylori infection, household composition, and family relationships. Blood samples were obtained from all consenting household members. Because of concerns about the accuracy of H. pylori serologic testing in you...

show abstract

“…In the developing world, the reinfection rates have ranged widely, from 1.1% at 2 years in China, to 73% at 8 months in studies from Peru. [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.…”

Section: Discussionmentioning

confidence: 99%

“…In developed countries, annual reinfection rates range from 0.36% in Australia to 5.7% in Italy [8][9][10][11][12][13][14][15] and in developing countries from 1.1% in China to 73% in Peru. [16][17][18][19][20][21][22] However, information regarding risk factors for reinfection is scanty.…”

Section: Introductionmentioning

confidence: 99%

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

McMahon

Bruce

Hennessy

et al. 2006

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

High rates of recurrence and of transient reinfections of Helicobacter pylori in a population with high prevalence of infection

Abstract: In our population, recurrence rate is high in adults and transient reinfection is common. In several cases, reinfection occurred by multiple strains, which suggests that soon after eradication, patients are exposed to multiple sources of reinfection.

Cited by 41 publications

References 33 publications

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

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

Significance of Transiently Positive Enzyme-Linked Immunosorbent Assay Results in Detection of Helicobacter pylori in Stool Samples from Children

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

Contact Info

Product

Resources

About

High rates of recurrence and of transient reinfections of Helicobacter pylori in a population with high prevalence of infection

Abstract: In our population, recurrence rate is high in adults and transient reinfection is common. In several cases, reinfection occurred by multiple strains, which suggests that soon after eradication, patients are exposed to multiple sources of reinfection.

Cited by 41 publications

References 33 publications

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

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

Significance of Transiently Positive Enzyme-Linked Immunosorbent Assay Results in Detection of Helicobacter pylori in Stool Samples from Children

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

Contact Info

Product

Resources

About

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

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