Niv Yaron, Hazazi Rachel
Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Helicobacter. 2008 Feb;13(1):56-61. doi: 10.1111/j.1523-5378.2008.00571.x.
Recurrence of Helicobacter pylori infection after eradication is rare in developed countries and more frequent in developing countries. Most recurrent cases are attributed to recrudescence (recolonization of the same strain within 12 months) rather than to reinfection (colonization with a new strain after more than 12 months). The aim of the study was to analyze recurrence rates in developed and developing countries and to deduce the relative roles of recrudescence and reinfection.
The PubMed database was searched up to January 31, 2007 using the keywords "Helicobacter pylori" or "H. pylori" and "recurrence" or "recrudescence," or "reinfection." Only prospective case studies in adults that used the (13)C-urea breath test ((13)CUBT) were included. Meta-analyses were performed with statdirect Statistical software, version 2.6.1, StatsDirect Ltd, Chesire, UK.
The literature search yielded 10 studies of H. pylori recurrence in developed countries (3014 patients followed for 24-60 months) and 7 studies in developing countries (2071 patients followed for 12-60 months). The calculated annual recurrence rates were 2.67% and 13.00%, respectively. Nested meta-analysis of cases with a longer follow-up after eradication revealed an annual recurrence rate of 1.45% (RR 0.54) in developed countries and 12.00% (RR 0.92) in developing countries.
The similarity of the annual recurrence rates during the first year after eradication and the annual recurrence rates in the second year after successful eradication in developing countries supports reinfection as the main cause in the second period. Therefore, a different approach for follow-up of H. pylori eradication may be needed between developed and developing countries.
幽门螺杆菌感染根除后复发在发达国家较为罕见，而在发展中国家更为常见。大多数复发病例归因于复发（12个月内同一菌株重新定植）而非再感染（12个月后新菌株定植）。本研究的目的是分析发达国家和发展中国家的复发率，并推断复发和再感染的相对作用。
截至2007年1月31日，使用关键词“幽门螺杆菌”或“幽门螺旋杆菌”以及“复发”或“再发”或“再感染”检索PubMed数据库。仅纳入使用（13）C-尿素呼气试验（（13）CUBT）的成人群前瞻性病例研究。使用英国柴郡StatsDirect Ltd公司的Statdirect统计软件2.6.1版进行荟萃分析。
文献检索得出10项关于发达国家幽门螺杆菌复发的研究（3014例患者随访24 - 60个月）和7项关于发展中国家的研究（2071例患者随访12 - 60个月）。计算得出的年复发率分别为2.67%和13.00%。对根除后随访时间较长的病例进行的巢式荟萃分析显示，发达国家的年复发率为1.45%（相对危险度0.54），发展中国家为12.00%（相对危险度0.92）。
发展中国家根除后第一年的年复发率与成功根除后第二年的年复发率相似，这支持再感染是第二个时期的主要原因。因此，发达国家和发展中国家在幽门螺杆菌根除后的随访可能需要不同的方法。
