Reinfection after successful eradication of Helicobacter pylori : a 2-year prospective study in Alaska Natives

Summary Background  Limited information exists regarding risk factors for reinfection after cure of Helicobacter pylori infection. Aim  To determine the 2-year reinfection rate of H. pylori in a cohort of urban Alaska Natives. Methods  Participants over 18 years of age undergoing oesophagogastroduodenoscopy had 13C urea breath test, culture, CLOtest and histology performed. Those diagnosed with H. pylori who tested urea breath test-negative at 8 weeks after treatment were followed prospectively at 4 months, 6 months, 1 year and 2 years. Subjects experiencing H. pylori reinfection as defined by a positive urea breath test were compared with those who did not become reinfected using univariable and multivariable analysis. Risk of reinfection over time was estimated by the Kaplan–Meier method. Results Helicobacter pylori reinfection occurred in 14 of 98 subjects successfully treated. The cumulative reinfection rate was 5.1% (95% CI: 0.7%–9.5%) at 4 months, 7.2% (2.0–12.3%) at 6 months, 10.3% (4.2–16.3%) at 1-year and 14.5% (7.5–21.6%) at 2 years. In multivariable analysis, a history of previous peptic ulcer disease or presence of ulcer at time of study oesophagogastroduodenoscopy were the only risk factors associated with reinfection (P = 0.01). Conclusions  Based on the findings from our study, subjects with a history of or current peptic ulcer disease should be followed, after successful treatment for H. pylori, with periodic urea breath test to detect reinfection, as reinfection would put them at high risk for ulcer recurrence.