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

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). C-14 urea breath test (C-14-UBT) was performed 4 weeks after the eradication therapy. The successfully treated patients were observed for 12 months with C-14-UBT to assess H. pylori status. If C-14-UBT was negative, it was repeated after every 12 weeks. If C-14-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 C-14-urea breath tests of all 102 patients who eradicated H. pylori remained negative up to 9 months. However, in 6 patients, the C-14-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.