FOLLOW-UP AFTER SUCCESSFUL ERADICATION OF HELICOBACTER-PYLORI - SYMPTOMS AND REINFECTION

The important long-term outcomes after Helicobacter pylori eradication are the proportion of patients with continuing symptoms, and the rate of recrudescence of the infection. Patients with proven H. pylori inf ection prior to treatment and a negative urea breath test at least 4 w eeks after completing treatment were invited to return for a further u rea breath test and a questionnaire. There were 167 patients and the m ean interval since the post-treatment urea breath test was 16 months. The endoscopic diagnoses were duodenal ulcer 72, duodenitis 17, gastri c ulcer 26, normal or oesophagitis 52. The ethnic groups were European 86, Maori 25, Pacific Island 28 and other ethnic groups 28. Ten patie nts (6%) had a positive urea breath test at follow up. The proportion of patients showing recrudescence of H. pylori was related to the delt a value (delta) of the post-treatment urea breath test: delta 0-2, fiv e of 146 (3.4%); delta 2-3, two of 18 (11%); and delta 3-4, three of f ive (60%). A symptom questionnaire was given to 147/157 patients with a persistently negative breath test; 60 had no symptoms, 31 had heartb urn, 30 had epigastric pain, 15 had both heartburn and epigastric pain , and 11 had nausea or other symptoms. There were fewer symptoms in pa tients with gastric ulcer (GU) compared with patients with duodenal ul cer (DU) and non-ulcer patients. Twenty-four patients (16%) were cakin g H-2-antagonists (including seven DU and five GU), 15 were taking ant acids :Ind four were taking omeprazole. There was no difference in med ication use between diagnostic groups. Eighteen of the 46 patients (39 %) with heartburn stated that this was a new symptom. Heartburn was a common symptom for duodenal ulcer patients after eradication (24/74, 3 2%). A second urea breath test 6-12 months after eradication is requir ed to definitely prove eradication. Patients with a breath test delta value of 2-4 should have a repeat urea breath test.