Gastroenterology

Gastroenterology

Volume 121, Issue 4, October 2001, Pages 792-798
Gastroenterology

Alimentary Tract
Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults,☆☆

https://doi.org/10.1053/gast.2001.28018Get rights and content

Abstract

Background & Aims: In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence. Methods: One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains. Results: Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) WITHIN the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori–negative patients. Conclusions: In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.

GASTROENTEROLOGY 2001;121:792-798

Section snippets

Patients

The study was approved by the Ethics Committee and Institutional Review Board of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh. Some 105 patients (95 men, 10 women; mean age, 36.1 years; range, 18–68; mean, body mass index 19.5; range, 15.1–26.1) were recruited at the BIRDEM, Institute of Postgraduate Medicine & Research, and Dhaka Medical College Hospital. The study took place between September 1996 and April

Recrudescence of H. pylori infection

Of the 105 patients with duodenal ulcer disease that finished eradication treatment, 8 were still H. pylori–positive (CLO test, 13C-UBT, histology) 1 month after the end of the treatment period, yielding an eradication rate of 92% according to the 4-week rule. Culture and DNA typing confirmed that all of the strains were identical before and after eradication treatment. During the next 2 months, 7 other patients showed a recurrence of H. pylori infection, which was again documented to be caused

Discussion

Our study aimed to distinguish between recrudescence and true reinfection of H. pylori after eradication treatment, and demonstrates a high reinfection rate of 18% per year in Bangladeshi adults. Although the mode of transmission of H. pylori has not yet been elucidated, our data suggest that exposure of adults to H. pylori results in a high infection rate and that recent infection does not provide adequate protection against recurrence. Late recrudescence occurred within 3 months after

Acknowledgements

The authors thank Jürgen Drewe, University Hospital Basel, for his contribution to statistical analysis and Kathleen A. Bucher for editorial assistance.

References (34)

  • J Parsonnet

    The incidence of Helicobacter pylori infection

    Aliment Pharmacol Ther

    (1995)
  • DY Graham et al.

    Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study

    Ann Intern Med

    (1992)
  • GD Bell et al.

    Reinfection or recrudescence after apparently successful eradication of Helicobacter pylori infection: implications for treatment of patients with duodenal ulcer disease

    Q J Med

    (1993)
  • A Ramirez-Ramos et al.

    Rapid recurrence of Helicobacter pylori infection in Peruvian patients after successful eradication

    Clin Infect Dis

    (1997)
  • N Kim et al.

    Helicobacter pylori reinfection rate and duodenal ulcer recurrence in Korea

    J Clin Gastroenterol

    (1998)
  • LG Coelho et al.

    Duodenal ulcer and eradication of Helicobacter pylori in a developing country. An 18-month follow-up study

    Scand J Gastroenterol

    (1992)
  • D Mahalanabis et al.

    Helicobacter pylori infection in the young in Bangladesh: prevalence, socioeconomic and nutritional aspects

    Int J Epidemiol

    (1996)
  • Cited by (92)

    • Helicobacter pylori-induced gastric carcinogenesis

      2021, Research and Clinical Applications of Targeting Gastric Neoplasms
    • Bismuth

      2015, Handbook on the Toxicology of Metals: Fourth Edition
    • Bismuth

      2014, Handbook on the Toxicology of Metals
    • Prevalence of Helicobacter pylori and its recurrence after successful eradication in a developing nation (Morocco)

      2013, Clinics and Research in Hepatology and Gastroenterology
      Citation Excerpt :

      More than 120 studies were published in the medical literature about recurrence of H pylori after successful eradication till today, and found a wide range of recurrence rates [5,6,14,33,34]. Recurrence of H. pylori is rare in developed countries such as Europe and the USA and more frequent in developing countries such as Peru, Brazil, Chile, Vietnam and Bangladesh, all of which are countries with a high prevalence of H. pylori infection [2,6,13–15,20,35–37]. In the US, Western Europe and Australia the rate of reinfection has ranged from 0 to 2.3%/year [38–44].

    View all citing articles on Scopus

    Address requests for reprints to: Niklaus Gyr, M.D., Master of Public Health and Tropical Medicine, Department of Internal Medicine, University Hospital Basel, CH-4031 Basel, Switzerland. e-mail: [email protected]; fax: (41) 61-265-4300.

    ☆☆

    Supported in part by a grant (32-45998.95) from the Swiss National Science Foundation, Swiss Agency for Development and Cooperation, Bern; Stanley Thomas Johnson Foundation, Bern; Roche Research Foundation, Basel; Freiwilligen Akademischen Gesellschaft, Basel; Ciba-Geigy Foundation, Basel; Sandoz Foundation, Basel, Switzerland.

    View full text