Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2017; 9(4): 184-193
Published online Apr 15, 2017. doi: 10.4251/wjgo.v9.i4.184
Helicobacter pylori recurrence after eradication in Latin America: Implications for gastric cancer prevention
Juan E Corral, Robertino Mera, Corey W Dye, Douglas R Morgan
Juan E Corral, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
Robertino Mera, Douglas R Morgan, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN 37232, United States
Corey W Dye, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Author contributions: Corral JE and Morgan DR designed the research; Corral JE and Dye CW performed the systematic review; Corral JE, Mera R and Morgan DR performed statistical analysis; Corral JE and Morgan DR wrote the manuscript; Mera R and Morgan DR critically reviewed the manuscript.
Supported by In part grants from the United States National Institutes of Health, Nos. CA1255884, CA167773, CA028842 (to Morgan DR).
Conflict-of-interest statement: The authors declare no conflict of interests.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at (douglas.morgan@vanderbilt.edu).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Douglas R Morgan, MD, MPH, Director for Latin America Sites, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, 1030C MRB IV, 2215 Garland Avenue, Nashville, TN 37232, United States. douglas.morgan@vanderbilt.edu
Telephone: +1-615-3229374
Received: October 11, 2016
Peer-review started: October 13, 2016
First decision: November 14, 2016
Revised: December 14, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: April 15, 2017
Processing time: 181 Days and 8.5 Hours
Abstract
AIM

To estimate Helicobacter pylori (H. pylori) recurrence rate in Latin America, a region with a significant H. pylori prevalence and gastric cancer burden.

METHODS

PubMed, LILACS, SciELO, Cochrane databases and abstracts from relevant meetings were reviewed. Information collected included: Participants’ characteristics, recruitment strategy, diagnostic modality, treatment arms, follow-up and recurrence rates. Recurrence was calculated using 100-patients-year rates, and data were pooled using a random effects model. The I2 statistic assessed between study heterogeneity. Meta-regression analyses evaluated for effect modifying variables.

RESULTS

Literature search yielded 163 articles. Twelve studies involving 4848 patients from 9 countries met inclusion criteria. Four hundred and thirty-two reinfections were recorded in 5487 person-years of follow-up. Pooled analysis showed a recurrence rate of 7.9 cases per 100 person-years (95%CI: 5.3-10.5). Meta-regression revealed that neither the antibiotic schema, a second antibiotic course, nor the diagnostic modality had an impact on the observed risk of recurrence. The recurrence rate in the first year after treatment, predominantly recrudescence, was 11.2 (6.1-16.4) per 100 patient years. Recurrence in subsequent years, was only 6.2 (3.8-8.7).

CONCLUSION

H. pylori recurrence rates in Latin America are significant, and with geographic variability, yet are acceptable based upon the current literature for consideration of large scale intervention trials. Further research in Latin America is warranted to evaluate the efficacy, cost-effectiveness, and potential adverse outcomes of proposed eradication programs.

Keywords: Gastric cancer; Reinfection; Hispanic; Helicobacter pylori; Latin America

Core tip: Latin America has a high burden of gastric cancer mortality, with significant geographical variability, which offers the opportunity for prevention trials and interventions. Recent trials and meta-analysis show that Helicobacter pylori (H. pylori) eradication reduces the risk of gastric adenocarcinoma. H. pylori reinfection rates in Latin America are similar to those seen in Asian trials. Recurrent cases occur mostly within the first year suggesting treatment failure (re-growth), not reinfection. These findings were not significantly modified by diagnostic modality, the antibiotics selected, retreatment, or the time check for eradication success. Eradication programs are a potentially attractive strategy for gastric cancer prevention in Latin America.