Helicobacter pylorirecurrence after eradication in Latin America: Implications for gastric cancer prevention

Abstract

AIMTo estimate Helicobacter pylori (H. pylori) recurrence rate in Latin America, a region with a significant H. pylori prevalence and gastric cancer burden.METHODSPubMed, LILACS, SciELO, Cochrane databases and abstracts from relevant meetings were reviewed. Information collected included: Participants’ characteristics, recruitment strategy, diagnostic modality, treatment arms, follow-up and recurrence rates. Recurrence was calculated using 100-patients-year rates, and data were pooled using a random effects model. The I2 statistic assessed between study heterogeneity. Meta-regression analyses evaluated for effect modifying variables.RESULTSLiterature search yielded 163 articles. Twelve studies involving 4848 patients from 9 countries met inclusion criteria. Four hundred and thirty-two reinfections were recorded in 5487 person-years of follow-up. Pooled analysis showed a recurrence rate of 7.9 cases per 100 person-years (95%CI: 5.3-10.5). Meta-regression revealed that neither the antibiotic schema, a second antibiotic course, nor the diagnostic modality had an impact on the observed risk of recurrence. The recurrence rate in the first year after treatment, predominantly recrudescence, was 11.2 (6.1-16.4) per 100 patient years. Recurrence in subsequent years, was only 6.2 (3.8-8.7).CONCLUSIONH. pylori recurrence rates in Latin America are significant, and with geographic variability, yet are acceptable based upon the current literature for consideration of large scale intervention trials. Further research in Latin America is warranted to evaluate the efficacy, cost-effectiveness, and potential adverse outcomes of proposed eradication programs.

Epidemiological and Clinical-Pathological Aspects of Helicobacter pylori Infection in Brazilian Children and Adults

“…In Latin America, after initial treatment, a mean eradication rate of 72.2% (ranging from 30.2% to 100%) has been observed. In Brazil, the eradication success rate ranges from 60.4% to 100% [ 30 ]. It should, however, be pointed out that the eradication rate has decreased over time to below 80%, due mainly to multiple antibiotic resistance and patient compliance [ 12 , 31 , 32 ].…”

Long-term follow-up of Helicobacter pylori reinfection and its risk factors after initial eradication: a large-scale multicentre, prospective open cohort, observational study

“…These treatment protocols achieve eradication rates ∼90% [10]. To prevent progression of premalignant histological changes (such as atrophic gastritis and intestinal metaplasia) and recurrent peptic ulcer diseases, it is important to maintain H. pylori eradication status after successful treatment [11]. However, a negative result of a follow-up test after H. pylori treatment does not guarantee subsequent persistent eradication status in the future, even with the most effective treatment regimen currently available [12].…”

Inference from the analysis of genetic structure of Helicobacter pylori strains isolates from two paediatric patients with recurrent infection

“…The presence of identical genotypes at different times indicates treatment failure: the bacterium was suppressed but not eradicated. Xia et al [32] reported the unsuitability of certain antimicrobial therapies for H. pylori because they do not completely eradicate infection, thus resulting in recurrence. The presence of antibiotic-resistant strains is one of the most frequent causes of recurrent H. pylori infection; in this situation, selection pressure is exerted, resulting in the death of sensitive strains and the persistence of resistant strains.…”