the recurrence of helicobacter pylori infection: incidence and variables influencing it. a critical...

The Recurrence of Helicobacter pylori Infection: Incidence and

Variables Influencing It. A Critical Review

Ph.D. candidate: Tian-yi Wang

Gisbert J P. The recurrence of Helicobacter pylori infection: incidence and variables influencing it. A critical review[J]. The American journal of gastroenterology, 2005, 100(9): 2083-2099.

Index

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Background

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•H. pylori infection has been a worldwide health, medical, and economics problem as a chronic bacterial infection.

•The eradication of H. pylori could significantly reduce the prevalence of various gastric diseases.

Background

Background

•The long-term effectiveness of H. pylori eradication programs will also depend on recurrence risk.

Definitions

Recurrence

Hp(+)Pretreatment

Hp(-)6-8 weeks after

treatment

Hp(+)Posttreatment（ e.g. 1 year or

later）

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Recrudescence

Reinfection

Treatment 6-8 weeks 1 year or later

limit of detection

limit of detection

Objective

Objective

•To estimate risk of H. pylori recurrence

•To examine the different variables that may influence its reappearance

Methods

Methods

•Bibliographical searches in MEDLINE electronic database

•Key Words “Helicobacter pylori” or “H. pylori” “recurrence” or “recurred” or

“recrudescence” or “reinfection” or “reinfection” or “reinfected”

Methods

•Variables extracted ▫author, population, country, eradication

treatment, waiting time to define eradication, diagnostic methods, follow-up time of the study patients, number of reinfections per total patients.

Results

Results_ incidence of recurrence•117 literatures satisfy the conditions

•the recurrence rate of H. pylori infection varied from 0% to more than 50%.

•mean annual recurrence rate (per patient-year of follow up) was 4.5% (95% CI, 4.2–4.8%).

Results_ incidence of recurrence•mean annual recurrence rate

▫Developed countries 3.4%▫Developing countries 8.7%

•Nevertheless, the recurrence rates are not always consistent with the prevalence of infection in some regions such as Japan and Korea.

Results_ variables influencing recurrence

•The time to confirm successful treatment▫4 wk after completing treatment 4.6%▫8 wk after completing treatment 3.5%

•Efficacy of eradication treatment▫The choice of antibiotic, bismuth, proton

pump inhibitor or H2-antagonist

•Diagnostic methods to check for H. pylori eradication

▫the rapid urease test, the urea breath test, gastric biopsy etc.

▫sensitivity of techniques

Results_ variables influencing recurrence

•Cut-off point for the urea breath test ▫the value of the breath test after treatment

for patients suffering a recurrence is higher.

▫Selection of a lower cut-off value may be helpful to maintain the diagnostic accuracy.

Results_ variables influencing recurrence

Results_ variables influencing recurrence

• Infection status of Family members and partners

▫intrafamilial clustering▫children are important in the transmission▫But the patient’s partner may not act as a

reservoir for the reinfection.

Conclusion

Conclusion

• mean annual recurrence rate was 4.5% globally.

• Annual recurrence rate in developed countries is lower than that in developing countries.

• The time to confirm successful treatment, efficacy of eradication treatment, diagnostic methods, cut-off point for the urea breath test are all variables influencing recurrence.

Thank you ！

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