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Alsahafi M, Mosli M, Alkhowaiter S, Donnellan F. Decision-Utility Analysis of Empiric Treatment Versus Test and Treat Strategies for Helicobacter pylori in Patients With Duodenal Ulcer. Value Health Reg Issues 2024; 39:1-5. [PMID: 37967489 DOI: 10.1016/j.vhri.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/12/2023] [Accepted: 08/16/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES The optimal strategy of Helicobacter pylori eradication in patients with duodenal ulcer is unclear. In this study, we aimed to compare the utility and the ulcer recurrence rate using the empiric treatment versus the test and treat strategies in patients with uncomplicated duodenal ulcer. METHODS A decision-utility analysis was performed using a decision tree. The empiric treatment strategy was compared with the test and treat strategy. The probabilities of recurrent ulcers were determined and utilities of the 2 strategies were compared using the quality-adjusted life-year (QALY). Sensitivity analysis was performed to evaluate for model robustness. RESULTS The probability of recurrent ulcer with the empiric strategy was 10.5%. The probabilities of recurrent ulcer with the test and treat strategy were 12.6%, 14.7%, 16.8%, and 17.9% based on 95%, 90%, 85%, and 80% sensitivity for histopathology, respectively. At the 95% estimate for the sensitivity of histopathology, the empiric strategy was associated with greater QALY compared with the test and treat strategy, 0.9875 versus 0.9853. The empiric treatment strategy was associated with greater QALY at extreme values for the estimates in our model. CONCLUSIONS The empiric treatment strategy is associated with 2.1% to 7.4% lower recurrence rate for a range of test sensitivity between 95% and 80%, and results in greater QALY compared with the test and treat strategy.
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Affiliation(s)
- Majid Alsahafi
- Division of Gastroenterology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mahmoud Mosli
- Division of Gastroenterology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad Alkhowaiter
- Division of Gastroenterology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fergal Donnellan
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Quach DT, Mai BH, Tran MK, Dao LV, Tran HV, Vu KT, Vu KV, Pham HTT, Bui HH, Ho DDQ, Trinh DT, Nguyen VT, Duong TH, Tran TTK, Nguyen HTV, Nguyen TT, Nguyen TD, Nguyen LC, Dao HV, Thai KD, Phan NT, Le LT, Vo CHM, Ho PT, Nguyen TL, Le QD, Le NV, Phan HQ, Nguyen BC, Tran TT, Tran TV, Ta L. Vietnam Association of Gastroenterology (VNAGE) consensus on the management of Helicobacter pylori infection. Front Med (Lausanne) 2023; 9:1065045. [PMID: 36714104 PMCID: PMC9878302 DOI: 10.3389/fmed.2022.1065045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is prevalent and has a rapidly increasing antibiotic resistance rate in Vietnam. Reinfection is quite common, and gastric carcinoma remains one of the most common malignancies, which is not uncommon to develop after successful eradication. The purpose of this consensus is to provide updated recommendations on the management of H. pylori infection in the country. The consensus panel consisted of 32 experts from 14 major universities and institutions in Vietnam who were invited to review the evidence and develop the statements using the Delphi method. The process followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The consensus level was defined as ≥80% for agreement on the proposed statements. Due to the limited availability of high-quality local evidence, this consensus was also based on high-quality evidence from international studies, especially those conducted in other populations in the Asia-Pacific region. The panel finally reached a consensus on 27 statements after two voting rounds, which consisted of four sections (1) indications for testing and selection of diagnostic tests (2), treatment regimens, (3) post-treatment confirmation of H. pylori status, and (4) reinfection prevention methods and follow-up after eradication. Important issues that require further evidence include studies on third-line regimens, strategies to prevent H. pylori reinfection, and post-eradication follow-up for precancerous gastric lesions. We hope this consensus will help guide the current clinical practice in Vietnam and promote multicenter studies in the country and international collaborations.
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Affiliation(s)
- Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam,Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam,*Correspondence: Duc Trong Quach, ; orcid.org/0000-0003-0141-921X
| | - Bang Hong Mai
- 108 Military Central Hospital, Hanoi, Vietnam,Bang Hong Mai,
| | - Mien Kieu Tran
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Long Van Dao
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Huy Van Tran
- Hue University of Medicine and Pharmacy, Hue, Vietnam
| | | | | | - Ho Thi-Thu Pham
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang Huu Bui
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | - Vinh Thuy Nguyen
- Department of Internal Medicine, Hanoi National University, Hanoi, Vietnam
| | - Thai Hong Duong
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Tuong Thi-Khanh Tran
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Hang Viet Dao
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | | | | | | | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nho Viet Le
- Department of Internal Medicine, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | | | | | - Trung Thien Tran
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Long Ta
- 108 Military Central Hospital, Hanoi, Vietnam
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Kayali S, Manfredi M, Gaiani F, Bianchi L, Bizzarri B, Leandro G, Di Mario F, De' Angelis GL. Helicobacter pylori, transmission routes and recurrence of infection: state of the art. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:72-76. [PMID: 30561421 PMCID: PMC6502203 DOI: 10.23750/abm.v89i8-s.7947] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori (H. pylori) infection is one of the most common infection in humans, affecting more than half of the population. The prevalence of the infection varies widely in rural developing areas (more than 80%) compared to urban developed ones (less than 40%), as a consequence of different socioeconomic and hygienic conditions. H. pylori infection is usually acquired during childhood; infected people usually remain asymptomatic, but about 30% of individuals may develop mild to severe upper gastrointestinal diseases such as gastritis, peptic ulcer, gastric cancer or MALT lymphoma. The transmission route is not clear yet; the person-to-person transmission, especially within the same family appears to be prevalent, but also environmental contamination is possible. The eradication without a specific therapeutic regimen is very unlikely and the reinfection rate after an effective eradication therapy is quite rare. The reinfection rate will increase if there are family members affected.
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Affiliation(s)
- Stefano Kayali
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Mahachai V, Vilaichone RK, Pittayanon R, Rojborwonwitaya J, Leelakusolvong S, Maneerattanaporn M, Chotivitayatarakorn P, Treeprasertsuk S, Kositchaiwat C, Pisespongsa P, Mairiang P, Rani A, Leow A, Mya SM, Lee YC, Vannarath S, Rasachak B, Chakravuth O, Aung MM, Ang TL, Sollano JD, Trong Quach D, Sansak I, Wiwattanachang O, Harnsomburana P, Syam AF, Yamaoka Y, Fock KM, Goh KL, Sugano K, Graham D. Helicobacter pylori management in ASEAN: The Bangkok consensus report. J Gastroenterol Hepatol 2018; 33:37-56. [PMID: 28762251 DOI: 10.1111/jgh.13911] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review and evaluate clinical aspects of H. pylori infection and to develop consensus statements, rationales, and grades of recommendation for the management of H. pylori infection in clinical practice in ASEAN countries. This ASEAN Consensus consisted of 34 international experts from 10 ASEAN countries, Japan, Taiwan, and the United States. The meeting mainly focused on four issues: (i) epidemiology and disease association; (ii) diagnostic tests; (iii) management; and (iv) follow-up after eradication. The final results of each workshop were presented for consensus voting by all participants. Statements, rationale, and recommendations were developed from the available current evidence to help clinicians in the diagnosis and treatment of H. pylori and its clinical diseases.
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Affiliation(s)
- Varocha Mahachai
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Ratha-Korn Vilaichone
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Rapat Pittayanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | | | | | - Monthira Maneerattanaporn
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Peranart Chotivitayatarakorn
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Sombat Treeprasertsuk
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chomsri Kositchaiwat
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pisaln Mairiang
- Department of Medicine, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand
| | - Aziz Rani
- Department of Gastroenterology and Hepatology, University of Jakarta, Jakarta, Indonesia
| | - Alex Leow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Swe Mon Mya
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Oung Chakravuth
- Calmette Hospital, University of Health Science, Phnom Penh, Cambodia
| | - Moe Myint Aung
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Tiing-Leong Ang
- Department of Gastroentrology and Hepatology, Changi General Hospital, Singapore
| | - Jose D Sollano
- Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | | | | | | | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Depok, Indonesia
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kwong-Ming Fock
- Faculty of Medicine, National University of Singapore, Singapore
| | - Khean-Lee Goh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - David Graham
- Department of Medicine, Gastroenterology Section, Baylor College of Medicine and Michael E. DeBakey VA Medicine Center, Houston, Texas, USA
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Chang SS, Hu HY. Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients. Gut Liver 2016; 9:346-52. [PMID: 25167793 PMCID: PMC4413968 DOI: 10.5009/gnl13451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background/Aims The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.
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Affiliation(s)
- Shen Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.,Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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Archampong TNA, Asmah RH, Wiredu EK, Gyasi RK, Nkrumah KN, Rajakumar K. Epidemiology of Helicobacter pylori infection in dyspeptic Ghanaian patients. Pan Afr Med J 2015; 20:178. [PMID: 26430475 PMCID: PMC4577627 DOI: 10.11604/pamj.2015.20.178.5024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/20/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Helicobacter pylori is a gram-negative urease-producing bacterium causally linked with gastritis, peptic ulcer disease and gastric adenocarcinoma. Infection is more frequent and acquired at an earlier age in developing countries compared to European populations. The incidence of Helicobacter pylori infection in dyspeptic Ghanaian patients was 75.4%. However, epidemiological factors associated with infection vary across populations. Methods This study used a cross-sectional design to consecutively sample dyspeptic patients at the Endoscopy Unit of the Korle-Bu Teaching Hospital, Accra between 2010 and 2012. The study questionnaire elicited their epidemiological clinical characteristics. Helicobacter pylori infection was confirmed by rapid-urease examination of antral biopsies at upper Gastro-intestinal endoscopy. Results The sample population of dyspeptic patients attending the Endoscopy Unit for upper GI endoscopy yielded 242 patients of which 47.5% were females. The age distribution of H. pylori-infection was even across most age – groups, ranging from 69.2% (61 – 70) years to 80% (21 – 30) years. Helicobacter pylori prevalence decreased across areas mapping to the three residential classes in accordance with increasing affluence with rural areas having the highest prevalence. The unemployed and patients in farming had relatively high Helicobacter pylori infection rates of 92.3% and 91.7% respectively. Conclusion Helicobacter pylori is endemic in Ghana but the persistently high prevalence across age groups despite significant community anti-microbial use suggests likely re-crudescence or re-infection from multiple sources in a developing country. Socio-cultural factors such as residential class and farming may be facilitating factors for its continued prevalence.
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Affiliation(s)
- Timothy Nii Akushe Archampong
- Department of Medicine, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon Boundary, Accra, Ghana
| | - Richard Harry Asmah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Legon Boundary, Accra, Ghana
| | - Edwin Kwame Wiredu
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon Boundary, Accra, Ghana
| | - Richard Kwasi Gyasi
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon Boundary, Accra, Ghana
| | - Kofi Nyaako Nkrumah
- Department of Medicine, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon Boundary, Accra, Ghana
| | - Kumar Rajakumar
- Department of Infection, Immunity and Inflammation, University of Leicester Medical School, Leicester LE1 9HN, United Kingdom ; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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Chang SS, Hu HY. Association between early Helicobacter pylori eradication and a lower risk of recurrent complicated peptic ulcers in end-stage renal disease patients. Medicine (Baltimore) 2015; 94:e370. [PMID: 25569660 PMCID: PMC4602848 DOI: 10.1097/md.0000000000000370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
End-stage renal disease (ESRD) patients exhibit an increased incidence of peptic ulcer disease. Helicobacter pylori plays a central role in the development of peptic ulcers. The effect of early H pylori eradication on the recurrence of complicated peptic ulcer disease in ESRD patients remains unclear. The aim of the present study was to explore whether early H pylori eradication therapy in ESRD patients can reduce the risk of recurrent complicated peptic ulcers.We conducted a population-based cohort study and recruited patients with ESRD who had developed peptic ulcers. We categorized patients into early (time lag ≦120 days after peptic ulcer diagnosis) and late H pylori eradication therapy groups. The Cox proportional hazards model was used. The endpoint was based on hospitalization for complicated recurrent peptic ulcers.The early and late H pylori eradication therapy groups consisted of 2406 and 1356 ESRD patients, respectively, in a time lag of 120 days. After adjusting for possible confounders, the early eradication group exhibited a lower rate of complicated recurrent peptic ulcer disease (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.64-0.91, P = 0.003) in a time lag of ≦120 days, but a similar rate of complicated recurrent peptic ulcer disease in time lags of ≦1 year (HR = 0.97, 95% CI 0.79-1.19, P = 0.758) and 2 years (HR = 1.11, 95% CI 0.86-1.44, P = 0.433) compared with the late eradication group.We recommend administering H pylori eradication within 120 days after peptic ulcer diagnosis to H pylori infected ESRD patients who have developed peptic ulcers.
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Affiliation(s)
- Shen-Shong Chang
- From the Division of Gastroenterology (S-SC), Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch; School of Medicine (S-SC); Institute of Public Health & Department of Public Health (H-YH), National Yang-Ming University; and Department of Education and Research (H-YH), Taipei City Hospital, Taipei, Taiwan
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Abstract
OBIECTIVE The study aimed to investigate whether early Helicobacter pylori (H. pylori) eradication therapy in cirrhotic patients caused a dramatic reduction of recurrent peptic ulcers compared with those treated with a late eradication. METHODS We identified cirrhotic patients using the International Classifications of Diseases, Revision 9 (ICD-9-CM). Decompensated cirrhotic patients can apply for a catastrophic illness card and were identified via the ICD-9-CM codes 571.2, 571.5 and 571.6. Compensated cirrhotic patients were identified via the ICD-9-CM codes 571.2, 571.5 and 571.6, after excluded decompensated cirrhotic patients. We categorized patients into early (time lag ≤365 days after peptic ulcer diagnosis) and late (time lag >365 days) H. pylori eradication therapy groups. The end-point was the occurrence of recurrent peptic ulcers. Cox proportional hazards model was used to calculate the hazard ratios (HRs). RESULTS Altogether, 154 cirrhotic patients were included in the early H. pylori eradication group and 103 in the late H. pylori eradication group. Cirrhotic patients had a higher risk of recurrent peptic ulcers in the late H. pylori eradication group (HR 1.58, 95% CI 1.09-2.28, P = 0.015). However, the risk of recurrent peptic ulcers in alcoholic cirrhotic patients in both groups (HR 1.47, 95% CI 0.77-2.83, P = 0.247) was similar. CONCLUSIONS Early H. pylori eradication is associated with a lower risk of recurrent peptic ulcers in cirrhotic patients. H. pylori eradication is the mainstay for treating cirrhotic patients who have contracted peptic ulcers.
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Affiliation(s)
- Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan, China; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan, China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, China
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Kim SY, Hyun JJ, Jung SW, Koo JS, Yim HJ, Lee SW. Helicobacter pylori recurrence after first- and second-line eradication therapy in Korea: the problem of recrudescence or reinfection. Helicobacter 2014; 19:202-6. [PMID: 24612156 DOI: 10.1111/hel.12117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recurrence of Helicobacter pylori (H. pylori) infection is the result of either recrudescence or reinfection. Annual recurrence rates per patient-year of follow-up have been reported to vary across countries. The aim of this study was to analyze recurrence rates of H. pylori after first-line and second-line eradication therapies in Korea. MATERIALS AND METHODS From 2007 to 2010, 2691 patients with H. pylori infection received first-line therapy and 573 patients who failed to respond to first-line therapy received second-line therapy. H. pylori infection and the success of eradication were assessed by endoscopic biopsy and rapid urease test or (13) C-urea breath test. All patients were advised to undergo (13) C-urea breath test or esophagogastroduodenoscopy with biopsy or rapid urease test 6 months after eradication, with annual follow-up thereafter. RESULTS The eradication rate of the first-line therapy was 79.9% (1283/1605) and that of the second-line therapy was 90.4% (394/436) by per protocol analysis. Annual recurrence rates sharply declined after 2-year follow-up. Annual recurrence rates within and after 2-year follow-up were 9.3 and 2.0% after first-line therapy and those of second-line therapy were 4.5 and 2.9%, respectively. CONCLUSIONS Annual recurrence rates of H. pylori showed a sharp decline after 2-year follow-up after eradication in Korean adults, which is not higher than that of Western countries. Enough time interval after treatment (i.e., 2 years) is necessary to confirm eradication, and it would not be easy to distinguish between recurrence and recrudescence before 2 years without identifying H. pylori strains.
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Affiliation(s)
- Seung Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Prevalence of Helicobacter pylori and its recurrence after successful eradication in a developing nation (Morocco). Clin Res Hepatol Gastroenterol 2013; 37:519-26. [PMID: 23567104 DOI: 10.1016/j.clinre.2013.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/06/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In developed countries, reinfection after successful eradication of Helicobacter pylori appears unusual. High prevalences of H. pylori in developing countries may result in high reinfection rates. In Morocco, published studies regarding the prevalence of H. pylori are limited, and to our knowledge, there are no data regarding the reinfection rate of H. pylori after successful treatment. AIM The aim of this study was to determine the prevalence of H. pylori in our area, and the reinfection rate at 6 months and 1 year of follow-up after successful eradication. METHODS Consecutive patients with investigated ulcer or non-ulcer dyspepsia were prospectively enrolled in the Hassan II University Hospital of Fez. Patients with H. pylori infection were treated with a 1-week triple therapy or 10 day sequential therapy. Those tested urea breath test negative after 3 months of treatment were followed prospectively with repeated urea breath test at 6 months and 1 year. H. pylori status at endoscopic examination was determined by rapid urease test, histology, and culture. RESULTS Four hundred and twenty-nine patients were enrolled in the study, among them 324 patients (75.5%) presented with H. pylori infection. Two hundred and fifty-six (83.3%) patients had successfully eradicated H. pylori following treatment, among them, two patients (0.8%) were reinfected with H. pylori over 12 months. The rate of reinfection was 0.42% in the first 6 months and of 0.45% in the first year of the study. CONCLUSION The results of the present study demonstrate that firstly, prevalence of H. pylori is high (75.5%) in our area, secondly as in developed countries, there is a low (0.8%) but continuous risk of H. pylori infection in adulthood. A different approach for follow-up after H. pylori eradication is probably needed in patients of developing countries, since reinfection prevalence is different between countries.
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Kim MS, Kim N, Kim SE, Jo HJ, Shin CM, Park YS, Lee DH. Long-term follow up Helicobacter Pylori reinfection rate after second-line treatment: bismuth-containing quadruple therapy versus moxifloxacin-based triple therapy. BMC Gastroenterol 2013; 13:138. [PMID: 24050512 PMCID: PMC3848835 DOI: 10.1186/1471-230x-13-138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/12/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The increasing trend of antibiotic resistance requires effective second-line Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori after second-line treatment that would determine the long-term follow up effect of the rescue therapy. METHODS A total of 648 patients who had failed previous H. pylori eradication on standard triple therapy were randomized into two regimens: 1, esomeprazole (20 mg b.i.d), tripotassium dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (20 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, H. pylori tests were performed with 13C urea breath test or invasive tests. In patients who maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. For the evaluation of risk factors of reinfection, gender, age, clinical diagnosis, histological atrophic gastritis or intestinal metaplasia were analyzed. RESULTS The recrudescence rate of the EBMT was 1.7% and of the MEA group 3.3% (p = 0.67). The annual reinfection rate of H. pylori of EBMT was found to be 4.45% and the MEA group 6.46%. Univariate analysis (Log-rank test) showed no association with any clinical risk factor for reinfection. CONCLUSIONS The long-term reinfection rate of H. pylori stayed low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy; thus reinfection cannot affect the choice of second-line treatment. TRIAL REGISTRATION Clinical Trial Registration Number NCT01792700.
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Affiliation(s)
- Min Soo Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Hyun Jin Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Kim MS, Kim N, Kim SE, Jo HJ, Shin CM, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Lee DH, Kim JM, Jung HC. Long-term follow-up Helicobacter pylori reinfection rate and its associated factors in Korea. Helicobacter 2013; 18:135-42. [PMID: 23066652 DOI: 10.1111/hel.12018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The reinfection rate of Helicobacter pylori has been reported to be low in developed countries but high in developing countries. The aim of this study is to evaluate the long-term reinfection rate of H. pylori and to investigate its associated risk factors in South Korea. METHODS During 2003-2010, H. pylori-positive 970 patients received standard proton pump inhibitor (PPI)-based triple eradication therapy, and follow-up H. pylori tests were performed with (13) C urea breath test or invasive tests (Giemsa histology, CLO test, and culture) 4 weeks after completion of treatment. A total of 331 patients who were maintained an H. pylori-eradicated state at 1 year after eradication were divided into two groups according to reinfection. For the evaluation of risk factors of reinfection, gender, age, smoking, alcohol, income, education, gastrointestinal symptoms, clinical diagnosis, histologic atrophic gastritis or intestinal metaplasia, and clarithromycin resistance were analyzed. RESULTS The follow-up period was 18-95 months (mean: 37.1 months), and H. pylori reappeared in 36 of 331 patients (10.9%), resulting in the annual reinfection rate of 3.51% per year. Multivariate analysis showed that male gender (HR 2.28; 95% CI, 1.05-5.00, p = .037) and low monthly family income (≤5000$ vs >5000$) (HR 3.54; 95% CI, 1.08-11.67, p = .038) were associated with H. pylori reinfection. CONCLUSION This long-term reinfection rate of H. pylori stayed rather low (3.51% per year), and male and low income determined the reinfection, factors already known to be important for H. pylori infection.
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Affiliation(s)
- Min Soo Kim
- Department of Internal medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
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Bago I, Bago J, Plečko V, Aurer A, Majstorović K, Budimir A. The effectiveness of systemic eradication therapy against oral Helicobacter pylori. J Oral Pathol Med 2010; 40:428-32. [PMID: 21198868 DOI: 10.1111/j.1600-0714.2010.00989.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Helicobacter pylori infection is associated with numerous gastroduodenal diseases. The oral cavity could be a potential extragastric reservoir for H. pylori, and oral H. pylori might cause gastric reinfection after the eradication therapy. The aim of the study was to evaluate the presence of H. pylori in oral cavity of patients with gastric H. pylori infection and to examine the effectiveness of the eradication therapy against H. pylori in stomach and in the oral cavity. METHODS Fifty-six patients with chronic periodontitis and gastric H. pylori were enrolled in the study. Gastric H. pylori infection was determined using (13) C-urea breath test before and 3 months after eradication therapy. The presence of the oral H. pylori was assessed using polymerase chain reaction before and 3 months after eradication therapy. The 1-week eradication therapy consisted of amoxycilin 1 g, clarithromycin 500 mg, and proton pump inhibitor 20 mg twice a day. RESULTS Of 56 subjects with gastric infection, 23 (41.1%) harbored H. pylori in the oral cavity. Eradication rate in stomach was 78.3%, whereas in the oral cavity, H. pylori was not detected from any sample after the eradication therapy. CONCLUSION Almost half of the patients with gastric H. pylori harbored the bacterium in the oral cavity. After the eradication therapy, H. pylori was not detected in the oral cavity, what suggests high effectiveness of the therapy protocol in the oral cavity, or it is possible that oral H. pylori is of a transient character.
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Affiliation(s)
- Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
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14
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Ryu KH, Yi SY, Na YJ, Baik SJ, Yoon SJ, Jung HS, Song HJ. Reinfection rate and endoscopic changes after successful eradication of Helicobacter pylori. World J Gastroenterol 2010; 16:251-5. [PMID: 20066746 PMCID: PMC2806565 DOI: 10.3748/wjg.v16.i2.251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the long-term outcomes regarding reinfection with Helicobacter pylori (H. pylori) and endoscopic changes after successful H. pylori eradication.
METHODS: From June 1994 to January 2007, 186 patients (M:F = 98:88; mean age 50.0 ± 11.4 years), in whom H. pylori had been successfully eradicated, were enrolled. The mean duration of follow up was 41.2 ± 24.0 mo.
RESULTS: H. pylori reinfection occurred in 58 patients (31.2%). The average annual reinfection rate was 9.1% per patient year. No recurrence of peptic ulcer was detected at the follow up endoscopy. There were no significant differences between the H. pylori eradication regimens for the reinfection rate and no significant differences in endoscopic findings between the H. pylori-recurred group and the H. pylori-cured group.
CONCLUSION: The reinfection rate in Korea is 9.1% which represents a decreasing trend. There was no relationship between H. pylori infection status and changes in endoscopic findings. There was also no recurrence or aggravation of ulcers.
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Zhang YY, Xia HHX, Zhuang ZH, Zhong J. Review article: 'true' re-infection of Helicobacter pylori after successful eradication--worldwide annual rates, risk factors and clinical implications. Aliment Pharmacol Ther 2009; 29:145-60. [PMID: 18945250 DOI: 10.1111/j.1365-2036.2008.03873.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The incidence of 'true' re-infection with Helicobacter pylori after successful eradication remains uncertain. AIM To determine the worldwide rates, risk factors and clinical implications of 'true' re-infection of Helicobacter pylori. 'True' re-infection of H. pylori is defined as the situation where tests for H. pylori infection, which were negative for 12 months after eradication, become positive again at a later stage. RESULTS Thirty six studies were identified through a literature search to be able to produce annual rates of 'true' re-infection, and data from 33 original articles were considered reliable and adequate in the further review. Generally, the reported rates varied from 0% to 23.4% in adults and from 1.9% to 9.6% in children. Most studies from developed countries reported rates of less than 1%, whereas relatively higher rates were reported in most of the developing countries. Small sample sizes included in the studies appeared to be associated with increased re-infection rates. Interfamilial transmission is the major cause of re-infection, although iatrogenic re-infection through contaminated endoscopic equipment has been reported. CONCLUSION Helicobacter pylori re-infection is not a concern in a clinical setting, especially in the developed world; however, caution must be exercised in most developing countries.
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Affiliation(s)
- Y-Y Zhang
- Department of Microbiology and Microbial Engineering, School of Life Sciences, Fudan University, Shanghai, China
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16
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Lee YC, Lin JT, Wu HM, Liu TY, Yen MF, Chiu HM, Wang HP, Wu MS, Hsiu-Hsi Chen T. Cost-effectiveness analysis between primary and secondary preventive strategies for gastric cancer. Cancer Epidemiol Biomarkers Prev 2007; 16:875-85. [PMID: 17507609 DOI: 10.1158/1055-9965.epi-06-0758] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The present study is done to assess the relative cost-effectiveness, optimal initial age, and interscreening interval between primary and secondary prevention strategies for gastric cancer. METHODS Base-case estimates, including variables of natural history, efficacy of intervention, and relevant cost, were derived from two preventive programs targeting a high-risk population. Cost-effectiveness was compared between chemoprevention with (13)C urea breath testing followed by Helicobacter pylori (H. pylori) eradication and high-risk surveillance based on serum pepsinogen measurement and confirmed by endoscopy. The main outcome measure was cost per life-year gained with a 3% annual discount rate. RESULTS The incremental cost-effectiveness ratio (ICER) for once-only chemoprevention at age 30 years versus no screening was U.S. $17,044 per life-year gained. Eradication of H. pylori at later age or with a periodic scheme yielded a less favorable result. Annual high-risk screening at age of 50 years versus no screening resulted in an ICER of U.S. $29,741 per life-year gained. The ICERs of surveillance did not substantially vary with different initial ages or interscreening intervals. Chemoprevention could be dominated by high-risk surveillance when the initial age was older than 44 years. Otherwise, chemoprevention was more cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness was most sensitive to the infection rate of H. pylori and proportion of early gastric cancer in all detectable cases. CONCLUSIONS Early H. pylori eradication once in lifetime seems more cost-effective than surveillance strategy. However, the choice is still subject to the risk of infection, detectability of early gastric cancer, and timing of intervention.
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Affiliation(s)
- Yi-Chia Lee
- Institute of Preventive Medicine and Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 521, No. 17, Hsu-Chow Road, 100 Taipei, Taiwan
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17
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Egan BJ, O'Morain CA. A historical perspective of Helicobacter gastroduodenitis and its complications. Best Pract Res Clin Gastroenterol 2007; 21:335-46. [PMID: 17382281 DOI: 10.1016/j.bpg.2006.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The discovery of Helicobacter pylori was one of the most notable in gastroenterology - and indeed medicine. The century before Marshall and Warren's discovery is peppered with isolated accounts of spiral-shaped bacteria in the stomach. The discovery of H. pylori, and the recognition of its importance, came about as a consequence of combined clinical, pathological and microbiological work. The discovery has transformed the treatment of peptic ulcers and other related diseases.
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Affiliation(s)
- Brian J Egan
- Department of Gastroenterology, Adelaide and Meath Hospital Tallaght, Trinity College Dublin, Ireland
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Kast RE. Some fibrocystic breast change may be caused by sexually transmitted H. pylori during oral nipple contact: supporting literature and case report of resolution after gut H. pylori eradication treatment. Med Hypotheses 2006; 68:1041-6. [PMID: 17113238 DOI: 10.1016/j.mehy.2006.09.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 09/25/2006] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To briefly review previously published evidence for Helicobacter pylori (Hp), colonization of extra-intestinal sites and suggest an hypothesis that breast acini and ducts be added to this list, concluding such breast colonization is not rare and is a sexually transmitted infection. METHODS PubMed literature search and review with a case report. CONCLUSIONS (1) Evidence indicates oral Hp is common and can remain in the mouth after successful eradication in stomach and duodenum. (2) Evidence indicates that the breast is also occasionally colonized by Hp. (3) Hp may be injected retrograde up into ducts of the breast during oral nipple stimulation during sexual activity and this Hp may give rise to some cases of fibrocystic breast change. (4) A case of painful fibrocystic change that had been present for two years in a 27 year old female, resolved after gastrointestinal Hp treatment.
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Affiliation(s)
- R E Kast
- Department of Psychiatry, University of Vermont, 2 Church Street, Burlington, VT 05401, USA.
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Saad RA. Re-infection following successful eradication of Helicobacter pylori infection. Aliment Pharmacol Ther 2006; 24:695-6; author reply 696-8. [PMID: 16907902 DOI: 10.1111/j.1365-2036.2006.03006.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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