HELICOBACTER-PYLORI REINFECTION AFTER APPARENT ERADICATION - THE IPSWICH EXPERIENCE

The reported rate of Helicobacter pylori reinfection following eradica tion therapy is highly variable. In Ipswich, the C-14-urea breath test (UBT) has been used since 1986 as a tool to study H. pylori eradicati on and reinfection. Updated results from 1182 patients in whom the org anism had apparently been successfully eradicated, following a number of different eradication regimens between October 1986 and 31 March 19 95, are presented. During this period, 57 'reinfections' were observed , of which 45 had occurred within 6 months of treatment. After the fir st year, the 'reinfection' rate was less than 0.6% per year. The crite rion for eradication of the infection was a UBT (2-hour area under cur ve) of less than 40 at least 1 month after treatment. The treatment re gimens were arbitrarily divided into five groups with eradication rate s of: less than 20%, 20-39%, 40-59%, 60-79% and over 80%. In these gro ups, the 6-month' reinfection' rates were 28.8%, 15.8%, 16.4%, 4.6% an d 1.7%, respectively (p < 0.001). These and other data presented in th e paper strongly suggest that, in Westernized countries, most so-calle d reinfections in adults are in fact the late recrudescence of a suppr essed infection rather than a true reinfection. Our data also suggest that the true reinfection rate is particularly low if the eradication therapy chosen has an efficacy of more than 85%. Several effective and well-tolerated 1-week triple H. pylori eradication regimens are now a vailable, and we would advocate their use in preference to the less ef fective dual regimens where initial eradication rates are lower and th ere is consequently a higher risk of 'reinfection'. We would predict t hat even in developing countries with a high prevalence of metronidazo le-resistant H. pylori, the 'reinfection' rate would be low if a combi nation of omeprazole, amoxycillin and clarithromycin were to be used.