Recurrence of Helicobacter Pylori Infection and Duodenal Ulcer Relapse, Following Successful Eradication in an Urban East Asian Population

CJL Khor, KM Fock, TM Ng, EK Teo, CS Sim, AL Tan, A Ng
Correspondence: Dr Christopher Khor, ckhor@bigfoot.com

ABSTRACT
We aimed to determine the rate of Helicobacter pylori (HP) recurrence and duodenal ulcer relapse in patients of a hospital in Singapore over a period of at least one year from the time of eradication. Ninety-six consecutive duodenal ulcer patients with biopsy-proven HP eradication and healed ulcer were seen at 3-month intervals, and follow-up endoscopy was performed when dyspepsia recurred, at the end of one year after eradication, or at the time of recall if the patient had been lost to follow-up. HP status was determined by antral and corpus biopsies and by antral cultures. Sixty-five had been given triple therapy, and 31 received dual therapy with omeprazole + amoxycillin or clarythromycin. Median time to follow-up endoscopy was 12 months. Six patients (6.25%) were positive for HP infection after eradication. Recurrence of HP infection was detected at 9 and 10 months after confirmation of HP eradication in two patients, and at between 13 and 20 months in the remaining four. Two of these had recurrent duodenal ulcer; all but one had erosive duodenitis. Two other patients had recurrent duodenal ulcer despite absence of HP reinfection; they admitted to taking low-dose aspirin. It was concluded that the recurrence of HP infection is low at the end of one year after successful eradication therapy in this urban East Asian population. Ulcer relapse occurred in 4.17% (4/96) of patients, and was associated with recurrent HP infection or NSAID exposure.

Keywords: Helicobacter pylori, Drug Therapy, Combination, Peptic Ulcer, Follow-up studies, Recurrence
Singapore Med J 2000; 41(8): 382-386