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H Pylori Recurrence After Successful Eradication

Yaron Niv www.wjgnet.com Yaron Niv, Department of Gastroenterology, Rabin Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel 


Author contributions: Niv Y designed research, analyzed data and wrote the paper. 


Correspondence to: Yaron Niv, Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 100 Jabotinski Street, Petach Tikva 49100, Israel. yniv@clalit.org.il 

Telephone: +972-3-9377237 Fax: +972-3-9210313 Received: January 5, 2008 

Revised: January 30, 2008


Abstract Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries. Recrudescence (recolonization of the same strain within 12 mo after eradication) rather than reinfection (colonization with a new strain, more than 12 mo after eradication) is considered to be responsible for most of the cases. This observation was confirmed only in developed countries, while in developing countries a recent meta-analysis demonstrated a high rate of reinfection. The proportion of H pylori annual recurrence was 2.67% and 13.00% in developed and developing countries, respectively. 


Nested meta-analysis (only cases with a longer follow-up and a negative 13CUBT a year after eradication) revealed annual recurrence rate of 1.45% [relative risk (RR), 0.54] and 12.00% (RR, 0.92) in developed and developing countries, respectively. These findings support the notion that in developed countries many cases of recurrence are due to recrudescence within the first year after eradication, with a 46% drop in the recurrence rate after the first year post eradication, while in developing countries reinfection is more pronounced, and continue at the same rate since eradication. 


A different approach for follow-up after H pylori eradication is probably needed in patients of developing countries, since reinfection is highly prevalent.

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