Recurrent peptic ulcers in patients following successful Helicobacter pylori eradication: a multicenter study of 4940 patients.
OBJECTIVE
Although curative treatment of Helicobacter pylori infection markedly reduces the relapse of peptic ulcers, the details of the ulcers that do recur is not well characterized. The aim of this study is to describe the recurrence rate and specific features of peptic ulcers after cure of H. pylori infection.


METHODS
This was a multicenter study involving 4940 peptic ulcer patients who were H. pylori negative after successful eradication treatment and were followed for up to 48 months. The annual incidence of ulcer relapse in H. pylori-cured patients, background of patients with relapsed ulcers, time to relapse, ulcer size, and site of relapsed ulcers were investigated.


RESULTS
Crude peptic ulcer recurrence rate was 3.02% (149/4940). The annual recurrence rates of gastric, duodenal and gastroduodenal ulcer were 2.3%, 1.6%, and 1.6%, respectively. Exclusion of patients who took NSAIDs led annual recurrence rates to 1.9%, 1.5% and 1.3%, respectively. The recurrence rate was significantly higher in gastric ulcer. Recurrence rates of patients who smoked, consumed alcohol, and used NSAIDs were significantly higher in those with gastric ulcer recurrence compared to duodenal ulcer recurrence (e.g. 125 of 149 [83.9%] relapsed ulcers recurred at the same or adjacent sites as the previous ulcers).


CONCLUSIONS
Curative treatment of H. pylori infection is useful in preventing ulcer recurrence. Gastric ulcer is more likely to relapse than duodenal ulcer. Recurrent ulcer tended to recur at the site of the original ulcers.
Miwa
Hiroto
H
Department of Gastroenterology, Juntendo University School of Medicine,Tokyo, Japan.
Sakaki
Nobuhiro
N
Sugano
Kentaro
K
Sekine
Hitoshi
H
Higuchi
Kazuhide
K
Uemura
Naomi
N
Kato
Mototsugu
M
Murakami
Kazunari
K
Kato
Chieko
C
Shiotani
Akiko
A
Ohkusa
Toshifumi
T
Takagi
Atsushi
A
Aoyama
Nobuo
N
Haruma
Ken
K
Okazaki
Kazuichi
K
Kusugami
Kazuo
K
Suzuki
Masayuki
M
Joh
Takashi
T
Azuma
Takeshi
T
Yanaka
Akinori
A
Suzuki
Hidekazu
H
Hashimoto
Hiroshi
H
Kawai
Takashi
T
Sugiyama
Toshiro
T
D000428:Alcohol Drinking; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D004381:Duodenal Ulcer / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D010437:Peptic Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D013270:Stomach / Q000473:pathology; D013276:Stomach Ulcer / Q000453:epidemiology / Q000209:etiology / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal