A Prospective Research On The Recurrence Of Helicobacter Pylori After Successful Eradication And Its Risk Factors In Jiangxi Adults

Background and aim:Helicobater pylori?H.pylori?is closely related to the incidence of chronic gastritis,peptic ulcer,gastric cancer and gastric mucosa-associated lymphoma.In1994,the international agency for the research of cancer?IARC?classified H.pylori as a class I?definite?pathogenic factor for gastric cancer.Therefore,effective eradication and prevention of the recurrence of H.pylori are crucial for the prevention and treatment of H.pylori related diseases.Recent domestic and international consensus has defined H.pylorii related diseases as infectious diseases,which can be transmitted from person to person through the oral-oral,fecal-oral and gastro-oral routes.Therefore,it is inevitable to reinfect some patients after eradication of H.pylori,especially in economically underdeveloped countries and regions with poor health conditions.The recurrence of H.pylori after eradication or the failure of eradication may lead to the persistence and aggravation of the disease.Although there have been reports on the recurrence of H.pylori after eradication in some regions of China,the results show that the factors affecting the recurrence of H.pylori after eradication are diverse,which shows that the recurrence rate of H.pylori varies greatly in different regions,different populations and different environments.There have been no reports in jiangxi province.To this end,this paper carried out a prospective investigation on the recurrence of H.pylori after eradication in adults in jiangxi province and its possible risk factors,so as to provide a basis for the formulation of infection prevention strategies for H.pylori in China.Methods:1.The objection of study:Selection from February 1,2016 to October 1,2018 in the First Affiliated Hospital of Nanchang University by ¹³C-UBT DOB value>6‰?to rule out near the critical value of false positives,so the inclusion criteria was set for 4‰+2‰?or pathology immunohistochemical staining confirmed H.pylori positive,who recieved bismuth containing quadruple therapy or standard triple therapy to eradicate H.pylori,and met both inclusion and exclusion criteria were included in the study.2.Research process:All patients selected were enrolled voluntarily.After signing the informed consent,the investigation questionnaire was filled in,which included the basic personal information and the risk factors possibly related to the recurrence of H.pylori.The follow-up of ¹³C-UBT was conducted at the 6 month,1 year and 2year after eradication,and the follow-up was terminated when the patient showed positive results.3.Standards for recurrence,recrudescence and reinfection of H.pylori infection:in this study,¹³C-UBT test was performed at 6 months,1 year and 2 years after treatment completion,Any positive ¹³C-UBT results in 3 follow-up visits was a recurrence of H.pylori.if the DOB value was 4‰±2‰,patients were asked to conduct¹³C-UBT again one month later to determine the status of H.pylori infection.recrudescence were judged as the positive result within 6 months;negative results at 6 months and positive at later follow-up time were judged as renfection.No6-month follow-up was conducted,and a positive result in 1 or 2 years could not be determined as recrudescence or reinfection,but only as recurrence.4.Statistical analysis:Counting data were expressed as rate?%?and measurement data as mean±standard deviation.The risk ofH.pylori reinfection with time was estimated using the Kaplan-Meier method.To determine the risk factors for recurrence,we used the log-rank test.Cox proportional hazards model was used to adjust for various risk factors,and the results were expressed as hazard ratios?HR?and 95%confifidence intervals?CI?.All results were considered statistically signifificant when P<0.05.SPSS 22.0 software was used for all statistical analyses.Results:1 General information and follow-up response rateA total of 495 patients were performed with ¹³C urea breath test to confirm H.pylori status was nagetive 4 or 8 weeks after eradication,and 5 patients were dropped from the follow-up.490 patients who compelted the follow-up,including 230 male and 260 female which aged 18 to 70 years old,with a mean age of 45.10±11.66 years old.At 6 months after treatment,2 patients did not reach the follow-up time,493patients should be followed up,while the actual 386 patients were followed up,4patients were positive,and 107 patients were lost to follow-up.At 1 year,16 patients did not reach the follow-up time,and 473 patients should be followed up,factly 368patients were followed up while 12 cases were positive,and 105 cases were not followed up.The follow-up time was not reached for 383 patients at 2 years,78patients should be followed up,and the actual follow-up time was conducted for 52patients,and 4 patients were positive,26 patients were not followed up.The response rates at 6 months,1 year and 2 years of follow-up were 78.29%,77.80%and 66.67%,respectively.2 The recurrence rate,recrudescence rate and reinfection rate of H.pyloriA total of 495 patients were performed with ¹³C urea breath test to confirm H.pylori status was nagetive 4 or 8 weeks after the completion of treatment were followed up for 489 patient-years.386 patients were followed up for 6 months,368patients were followed up for 1 year,and 52 patients were followed up for 2years.During the 6-month follow-up period,4 cases were positive.In the 1-year follow-up period,12 cases were positive,and 7 cases were not followed up for 6months,so they could not be judged as recrudescence or reinfection,that is collectively referred to as recurrence,5 cases were negative at the 6-month follow-up,so they were considered as reinfection in this study.There were 4 positive cases in the2-year follow-up period,and a total of 20 cases with H.pylori positive which be called H.pylori recurrence.The annual recurrence rate and annual reinfection rate of H.pylori was 3.01%,1.91%,the recrudescence rate was 1.04%.3 Risk factors for recurrence of H.pyloriUnivariate analysis suggested that low family monthly income per person?P=0.015?and exposure to H.pylori infection in family members?P=0.020?were related to the recurrence of H.pylori.Multivariate analysis showed the same as low family monthly income per person?HR 3.601;95%CI:1.203-10.778,P=0.022?and exposure to H.pylori infection in family members?HR 1.726;95%CI:1.037-2.871,P=0.036?were independent risk factors for recurrence of H.pylori.Conclusion:1.There was recurrence after successful eradication of H.pylori,the annual recurrence and reinfection rate in Jiangxi province was 3.01%,1.91%,the recrudescence rate was 1.04%.2.Low family monthly income per person and exposure to H.pylori infection in family members were possible independent risk factors for H.pylori recurrence.