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News

Risk of recurrent H pylori infection after initial eradication

This  week's issue of the Journal of the American Medical Association investigates the risk of recurrent H pylori infection 1 year after initial eradication therapy in Latin American communities.

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The long-term effectiveness of Helicobacter pylori eradication programs for preventing gastric cancer will depend on recurrence risk and individual and community factors.

Dr Douglas Morgan and colleagues estimated the risk of H pylori recurrence and assess factors associated with successful eradication 1 year after treatment.

Cohort analysis of 1463 randomized trial participants aged 21 to 65 years from 7 Latin American communities, who were treated for H pylori and observed between 2009 and 2011.

Patients were randomized to 1 of 3 treatment groups, including 14-day lansoprazole, amoxicillin, and clarithromycin, 5-day lansoprazole and amoxicillin followed by 5-day lansoprazole, clarithromycin, and metronidazole, or 5-day lansoprazole, amoxicillin, clarithromycin, and metronidazole.

The research team reported that participants with a positive C-urea breath test (UBT) 6 to 8 weeks posttreatment were offered voluntary re-treatment with 14-day bismuth-based quadruple therapy.

One year after treatment for H pylori infection, recurrence occurred in 12%
Journal of the American Medical Association

Recurrent infection after a negative posttreatment urea breath test and factors associated with successful eradication at 1-year follow-up.

The doctors noted that among participants with urea breath test-negative results who had a 1-year follow-up urea breath test, 125 tested urea breath test positive, a recurrence risk of 12%.

Recurrence was significantly associated with study site, nonadherence to initial therapy, and children in the household.

The researchers found that of the 281 with positive posttreatment urea breath test results, 138 completed re-treatment, of whom 93 tested urea breath test negative at 1 year.

Among the 1340 who had a 1-year urea breath test, 80%, 79%, and 78% had urea breath test-negative results in the triple, sequential, and concomitant groups, respectively, with 79% overall effectiveness.

In a single-treatment course analysis that ignored the effects of re-treatment, the percentage of urea breath test-negative results at 1 year was and was significantly associated with study site, adherence to initial therapy, male sex, and age.

The team of doctors reported that one-year effectiveness among all 1463 enrolled participants, considering all missing urea breath test results as positive, was 73%.

Dr Morgan's team concluded, "One year after treatment for H pylori infection, recurrence occurred in 12% of participants who had negative posttreatment urea breath test results."

"Recurrence determinants may be as important as specific antibiotic regimen in determining the long-term success of H pylori eradication interventions."

"Study findings are relevant to the feasibility of programs for the primary prevention of gastric cancer in high-incidence regions of Latin America."

JAMA 2013; 309(6): 578-586
15 February 2013

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