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Open Access Research article

Low rate of recurrence of Helicobacter Pylori infection in spite of high clarithromycin resistance in Pakistan

Javed Yakoob1, Shahab Abid1*, Wasim Jafri1, Zaigham Abbas1, Khalid Mumtaz1, Saeed Hamid1 and Rashida Ahmed2

Author affiliations

1 Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan

2 Department of Pathology, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan

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Citation and License

BMC Gastroenterology 2013, 13:33  doi:10.1186/1471-230X-13-33

Published: 21 February 2013

Abstract

Background

The aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy.

Methods

One hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41 ± 13 years (range 18–77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP). 14C urea breath test (14C-UBT) was performed 4 weeks after the eradication therapy. The successfully treated patients were observed for 12 months with 14C-UBT to assess H. pylori status. If 14C-UBT was negative, it was repeated after every 12 weeks. If 14C-UBT was positive, endoscopy was repeated with biopsies.

Result

The eradication therapy was successful in 102(85%) patients. Out of forty-seven H. pylori isolates cultured, clarithromycin sensitivity was present in 30(64%) and amoxicillin in 45(98%), respectively. Follow-up 14C-urea breath tests of all 102 patients who eradicated H. pylori remained negative up to 9 months. However, in 6 patients, the 14C-UBT confirmed recurrence at 12 months. The recurrence rate was 6%.

Conclusion

A low rate of recurrence of H. pylori infection was found in patients with dyspeptic symptoms. H. pylori isolates demonstrated a high invitro clarithromycin resistance.

Keywords:
Helicobacter pylori; Clarithromycin resistance; Recurrence; Nonulcer dyspepsia