Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2016; 7(1): 181-185
Published online Feb 15, 2016. doi: 10.4291/wjgp.v7.i1.181
High rate of Helicobacter pylori reinfection in Lithuanian peptic ulcer patients
Laimas Jonaitis, Gediminas Kiudelis, Paulius Slepavicius, Limas Kupcinskas
Laimas Jonaitis, Gediminas Kiudelis, Paulius Slepavicius, Limas Kupcinskas, Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, LT-50028 Kaunas, Lithuania
Author contributions: Jonaitis L, Kiudelis G and Kupcinskas L designed and planned the study, recruited the patients, collected all the data, and performed all the investigations; Jonaitis L performed statistical analysis; Jonaitis L, Slepavicius P prepared the manuscript; all authors were involved in drafting and revising the manuscript.
Institutional review board statement: The study was reviewed and approved by the Kaunas Regional Biomedical Research Ethics Committee (Protocol No. 8/2011).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Laimas Jonaitis, Gediminas Kiudelis, Paulius Slepavicius, Limas Kupcinskas declare that there are no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at laimasj@takas.lt. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Laimas Jonaitis, MD, PhD, Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, LT-50028 Kaunas, Lithuania. laimasj@takas.lt
Telephone: +370-37326264 Fax: +370-37331458
Received: May 27, 2015
Peer-review started: May 29, 2015
First decision: June 19, 2015
Revised: August 19, 2015
Accepted: November 30, 2015
Article in press: December 3, 2015
Published online: February 15, 2016
Abstract

AIM: To evaluate the frequency of Helicobacter pylori (H. pylori) reinfection in peptic ulcer patients during 9 years after H. pylori eradication.

METHODS: We invited 117 peptic ulcer patients in whom eradication of H. pylori was confirmed 1 year after eradication treatment both by histology and by rapid urease test. In total, 57 patients were available for the study procedures: 34 (59.6%) male, 23 (40.4%) female; mean age 52.3 ± 13.0 years. There were 45 (78.9%) patients with duodenal ulcer and 12 (21.1%) with gastric ulcer. H. pylori was diagnosed by a rapid urease test and histology if endoscopy was performed. If endoscopy was refused, H. pylori was diagnosed by the C14-urea breath test and serology. H. pylori was established if at least one of the tests was positive.

RESULTS: The mean follow-up was 8.9 ± 1.0 years (range, 6-12). H. pylori was established in 15 patients. In 2 H. pylori-negative patients, H. pylori was established during the follow-up period and eradicated. Therefore, we consider that reinfection occurred in 17 patients. In the per protocol analysis, reinfection was established in 17 of 57 (29.8%; 95%CI: 19.2-42.2) patients during the follow-up period. The annual rate of infection was 3.36%. If all non-responders were considered H. pylori-negative, reinfection would be 14.5% (17/117), the annual rate being 1.63%. The mean age of patients with reinfection was 51.8 ± 14.0 years, and without reinfection was 52.5 ± 13.0 years, P > 0.05; the mean body mass index of patients with reinfection was 27.2 ± 4.1 kg/m2, and without reinfection was 25.7 ± 4.2 kg/m2, P > 0.05. There were no differences in the reinfection rates according the location of the peptic ulcer, the eradication regimen used, and smoking status.

CONCLUSION: The reinfection rate of H. pylori is relatively high in Lithuania and probably related to the high prevalence of H. pylori, what may reflect differences in the socioeconomic status between Western and Eastern European countries.

Keywords: Helicobacter pylori, Reinfection, Prevalence, Peptic ulcer, Eradication

Core tip: The reinfection rate of Helicobacter pylori (H. pylori) varies according to geographical area. In regions with higher socioeconomic status and lower prevalence of H. pylori it is only 1.68% of cases. In developing areas, the reinfection rate could be much higher. Lithuania, as well as other Eastern and Central European countries, is in transition, and the prevalence of H. pylori is not as low as in Western regions, but not as high as in developing countries. According to our study, the H. pylori reinfection rate in Lithuania is relatively high (the annual rate being 3.36%), probably because of the high prevalence of H. pylori. This could indirectly reflect differences in the socioeconomic status between Western and Eastern European countries.