1. The Recurrence of Helicobacter pylori Infection: Incidence and Variables Influencing It. A Critical Review Ph.D. candidate: Tian-yi Wang Gisbert J P. The recurrence of Helicobacter pylori infection: incidence and variables influencing it. A critical review[J]. The American journal of gastroenterology, 2005, 100(9): 2083-2099.

2. Index 2 Background Objective Methods Results Conclusion

3. Background 3

4. H. pylori infection has been a worldwide health, medical, and economics problem as a chronic bacterial infection. The eradication of H. pylori could significantly reduce the prevalence of various gastric diseases. Background

5. The long-term effectiveness of H. pylori eradication programs will also depend on recurrence risk.

6. Definitions

7. Recurrence Hp(+) Pretreatment Hp(-) 6-8 weeks after treatment Hp(+) Posttreatment （ e.g. 1 year or later ）

8. RecurrenceRecrudescenceReinfection 8

9. Recrudescence Reinfection Treatment6-8 weeks1 year or later limit of detection

10. Objective

11. To estimate risk of H. pylori recurrence To examine the different variables that may influence its reappearance

12. Methods

13. Bibliographical searches in MEDLINE electronic database Key Words  “Helicobacter pylori” or “H. pylori”  “recurrence” or “recurred” or “recrudescence” or “reinfection” or “reinfection” or “reinfected”

14. Methods Variables extracted ▫author, population, country, eradication treatment, waiting time to define eradication, diagnostic methods, follow-up time of the study patients, number of reinfections per total patients.

15. Results

16. Results_ incidence of recurrence 117 literatures satisfy the conditions the recurrence rate of H. pylori infection varied from 0 % to more than 50 %. mean annual recurrence rate (per patient-year of follow up) was 4.5 % ( 95 % CI, 4.2–4.8 %).

17. Results_ incidence of recurrence mean annual recurrence rate ▫Developed countries 3.4 % ▫Developing countries 8.7 % Nevertheless, the recurrence rates are not always consistent with the prevalence of infection in some regions such as Japan and Korea.

18. Results_ variables influencing recurrence The time to confirm successful treatment ▫ 4 wk after completing treatment 4.6% ▫ 8 wk after completing treatment 3.5% Efficacy of eradication treatment ▫The choice of antibiotic, bismuth, proton pump inhibitor or H 2 -antagonist

19. Diagnostic methods to check for H. pylori eradication ▫the rapid urease test, the urea breath test, gastric biopsy etc. ▫sensitivity of techniques Results_ variables influencing recurrence

20. Cut-off point for the urea breath test ▫the value of the breath test after treatment for patients suffering a recurrence is higher. ▫Selection of a lower cut-off value may be helpful to maintain the diagnostic accuracy. Results_ variables influencing recurrence

21. Infection status of Family members and partners ▫intrafamilial clustering ▫children are important in the transmission ▫But the patient’s partner may not act as a reservoir for the reinfection.

22. Conclusion

23. mean annual recurrence rate was 4.5 % globally. Annual recurrence rate in developed countries is lower than that in developing countries. The time to confirm successful treatment, efficacy of eradication treatment, diagnostic methods, cut-off point for the urea breath test are all variables influencing recurrence.

24. Thank you ！ 24