Editorial: recurrence of Helicobacter pylori infection—still the same after all these years… Authors’ reply

We thank Shah et al for their interest and comments regarding our recent publication.^1,2 We agree with the authors that additional factors (genetics and immune function and organism factors) also play an important role in Helicobacter pylori recurrence. Moreover, the authors noted that the influence of eradication therapy on H. pylori recurrence was not analysed in this article. Here we provide the available data from our review. We divided outcome according to eradication therapy (bismuth containing quadruple therapy, “classic” triple therapy, dual therapy and triple therapy). The recurrence rates were 4.3% (95% CI, 2–7), 2.9% (95% CI, 1–5), 4.2% (95% CI, 1–9) and 5.0% (95% CI, 3–7) for bismuth containing quadruple therapy, “classic” triple therapy, dual therapy and triple therapy, respectively. No significant differences were observed among groups (P >.05). However, only 70 studies had information available concerning the H. pylori recurrence rate. Recurrence can occur as a consequence of recrudescence or reinfection; the choice of eradication therapy should have influence on recrudescence rate. However, few articles provided data regarding recrudescence. It has long been known that poor therapies are associated with high recrudescence and we believe that efficacy of eradication therapy should be graded as excellent, good, poor or unacceptable.³

The authors noted that data which have identified clusters of infected individuals with similar DNA signatures are consistent with spread of infection between cluster members and/or an environmental exposure which is common to the cluster. We agree. Recurrence requires re-exposure and it may be prudent to treat groups of individuals (eg families or villages) in high prevalence regions.