The long-term reinfection rate and the course of duodenal ulcer disease after eradication of Helicobacter pylori in a developing country

OBJECTIVE: The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on the natural history of duodenal ulcer di sease and the reinfection rate after treatment in a developing country. METHODS: A total of 111 H. pylori-infected patients with duodenal ulcer wer e treated with either omeprazole or famotidine plus two antibiotics for 2 w k. Those failed to respond to treatment were retreated with bismuth-based t riple therapy. RESULTS: The radication rate was 76% (95% CI: 67-83%). Eventually, H. pylor i was eradicated in 96 of the 111 patients (86%), who were followed-up clin ically and endoscopically for a mean of 37.2 months. The cumulative reinfec tion rate after eradication (Kaplan-Meier) was 8% +/- 3% in yr 1, 11% +/- 4 % in yr 2, and 13% +/- 4% in yr 3. Nine of the 12 reinfections occurred dur ing yr 1. Recurrence of duodenal ulcer was detected in five patients (5.2%) , all of them during yr 1 of follow-up. Histologically, gastritis scores (a ccording to the Sydney system) improved significantly after eradication. CONCLUSIONS: In a high prevalence setting, H. pylori eradication and early reinfection rates after treatment are similar to rates observed in a low pr evalence environment, whereas the late reinfection rate seems to be higher. However, up to 3 yr after treatment, most treated patients are free of H. pylori infection and/or ulcer activity. Even longer follow-up studies are n ecessary to determine whether specific retreatment policies are necessary t o maintain long term eradication in developing countries.