Duodenal ulcer relapse is not always associated with recurrence of H-pylori infection: A prospective three-year follow-up study

Background. Long-term data concerning the reappearance of Helicobacter pylo ri infection and duodenal ulcer (DU) recurrence after successful eradicatio n are still few and conflicting. Inadequate histological assessment or use of indirect tests for the determination of H. pylori and bias in the select ion of patients to be controlled can influence reported results. The aim of this study was to determine the rate of recurrence of H. pylori infection and ulcer relapse in a population of cured DU patients followed up for 3 ye ars irrespective of their symptomatology. Methods. Between 1992 and 1994, 126 patients with DU disease were treated w ith double or triple therapy. Patients using nonsteroidal antiinflammatory drugs or aspirin or receiving maintenance antisecretory therapy were exclud ed. H. pylori infection was assessed by three bioptic tests from both the a ntrum and the body (culture, urease, histopathological examination). After 2 months from cessation of treatment, DU had healed and H. pylori infection was cured in 102 of 126 patients (81%). These patients were endoscopically followed up after 1 and 3 years, respectively, and were advised to contact us at symptom recurrence. At 1 and 3 years, we studied 95 (93.2%) and 79 ( 77.4%) patients, respectively, of the 102 who were cured. The other patient s were untraceable or refused endoscopy because they were asymptomatic. Results. After 1 year, no patient had H, pylori recurrence, whereas three p atients had a relapse of DU without evidence of infection. After 3 years, r ecurrence of H. pylori occurred in six patients (annual rate, 2.5%), DU rel apsed in five H. pylori-positive patients (6.3%) and in two H. pylori-negat ive patients (annual rate, 1.9%). Fasting gastrin and acid secretion values studied in all relapsed patients were within the normal range except for o ne H. pylori-positive patient. Conclusions. Recurrence of H. pylori infection is very low where treatment is effective, but a DU relapse, not related to acid hypersecretion, can occ ur in a small percentage of cured patients.