title: National rates of Helicobacter pylori recurrence are significantly and inversely correlated with human development index.
abstract: BACKGROUND
  Helicobacter pylori infection is a worldwide threat to human health with recurrence rates that vary widely. The precise correlation between H. pylori recurrence and socioeconomic development has not been determined.
  
  
  OBJECTIVE
  To determine H. pylori recurrence rates after successful eradication and their association with socioeconomic development metrics.
  
  
  METHODS
  Bibliographical searches were performed in the MEDLINE database. We reviewed all results, filtered by inclusion criteria, extracted primary results to calculate H. pylori recurrence rates and calculated national Human Development Index (HDI) values for the periods during which the studies were conducted.
  
  
  RESULTS
  One thousand two hundred and twenty six cases of H. pylori recurrence in 77 eligible studies were observed in 43 525.1 follow-up patient-years after successful eradication therapy, giving a recurrence rate of 2.82 ± 1.16% per patient-year (weighted mean ± 95% confidence interval). H. pylori recurrence rate was inversely correlated with national HDI on linear (r = -0.633) and weighted least square (r = -0.546) regression analysis. Countries with very high HDI had a mean recurrence rate significantly lower than that of high, medium and low HDI countries (P < 0.01, 0.001, and 0.001, respectively).
  
  
  CONCLUSIONS
  Less-developed areas, as measured by HDI, are more likely to have high H. pylori recurrence rates. A different approach to follow-up after H. pylori eradication is needed in developing countries where reinfection is highly prevalent, paying special attention to sources of reinfection and high-risk groups.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: T-L
authors.initials: TL
authors.lastname: Yan
authors.forename: Q-D
authors.initials: QD
authors.lastname: Hu
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.forename: Y-M
authors.initials: YM
authors.lastname: Li
authors.forename: T-B
authors.initials: TB
authors.lastname: Liang
mesh_terms: D019049:Developed Countries / Q000191:economics*; D003906:Developing Countries / Q000191:economics*; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D012008:Recurrence; D012959:Socioeconomic Factors; D013223:Statistics as Topic