Helicobacter pylori recurrence in patients with duodenal ulcer: Clinical, endoscopic, histologic, and genotypic aspects. A 10-year Brazilian series.
BACKGROUND
Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype.


METHODS
One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test.


RESULTS
H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified.


CONCLUSIONS
The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.
Eisig
Jaime N
JN
Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. eisig@uol.com.br
Zaterka
Schlioma
S
Silva
Fernando M
FM
Malfertheiner
Peter
P
Mattar
Rejane
R
Rodriguez
Tomás N
TN
Hashimoto
Cláudio L
CL
Iriya
Kioshi
K
Laudanna
Antonio A
AA
Moraes-Filho
Joaquim P P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004381:Duodenal Ulcer / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence