Five-year follow-up study after Helicobacter pylori eradication: Reinfection and peptic ulcer status

OBJECTIVE:  To investigate the prevalence of peptic ulcers and Helicobactor pylori reinfection 5 years after H. pylori eradication. METHODS:  One thousand and six adults were randomly sampled from the general population in a high-incidence region of gastric cancer. Of these, 552 subjects were confirmed to be H. pylori-positive by using both the rapid urease test and the Warthin−Starry stain. All H. pylori-positive subjects were randomly divided into two groups: (i) the eradication group, who received 1 week of omeprazole-based triple therapy; and (ii) the control group, who received placebo tablets. Four weeks after the cessation of treatment, 13C-urea breath tests demonstrated that H. pylori had been successfully eradicated in 88.9% of patients in the eradication group, whereas 96.4% of patients remained H. pylori positive in the control group. Subjects in both groups were followed up using endoscopy at the end of the first and fifth year after treatment. The H. pylori infection status was determined by using the rapid urease test and Warthin−Starry staining. RESULTS:  The response rates to endoscopy at the end of the first and fifth year were 89.3 and 83.11%, respectively. The prevalence of peptic ulcers in the eradication group and control group were 9.87 and 7.61% before treatment, 3.70 and 12.58% 1 year after treatment (P < 0.05), and 5.86 and 14.93% 5 years after treatment (P < 0.05), respectively. The recurrence rates of peptic ulcers in the eradication group and the control group were 3.70 and 38.10% 1 year after treatment, and 14.81 and 42.86% 5 years after treatment, respectively. The rates of H. pylori infection 1 and 5 years after treatment in the eradication group were 13.58, and 19.82%, respectively. In the control group, the rates of H. pylori infection were 91.97 and 83.26% 1 and 5 years after treatment, respectively. CONCLUSIONS:  The prevalence of peptic ulcers decreased significantly after the eradication of H. pylori. The reinfection rate after H. pylori eradication was 4−5% per year. Helicobacter pylori infection status remained constant in almost 85% of cases.