Helicobacter pylori recurrence after eradication in Latin America: Implications for gastric cancer prevention.
Helicobacter pylori recurrence after eradication in Latin America: Implications for gastric cancer prevention.
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DOI：
10.4251/wjgo.v9.i4.184
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发表时间：
2017-04-15
影响因子：
3
通讯作者：
Morgan DR
中科院分区：
文献类型：
--
作者：
Corral JE;Mera R;Dye CW;Morgan DR
估计幽门螺杆菌（H. pylori）在拉丁美洲的复发率，该地区的幽门螺杆菌患病率和胃癌负担都很高。对PubMed、LILACS、SciELO、Cochrane等数据库及相关会议摘要进行综述。收集的信息包括：参与者特征、招募策略、诊断方式、治疗组、随访和复发率。复发率采用100例患者年率计算，数据采用随机效应模型汇总。I2统计量评估研究间的异质性。meta回归分析评估了影响修正变量。文献检索得到163篇文章。来自9个国家的4848例患者的12项研究符合纳入标准。在5487人-年的随访中记录了432例再感染。合并分析显示复发率为7.9例/ 100人年（95%CI: 5.3-10.5）。meta回归显示，抗生素方案、第二次抗生素疗程和诊断方式对观察到的复发风险都没有影响。治疗后第一年的复发率（以复发为主）为11.2(6.1-16.4)/ 100患者年。随后几年的复发率仅为6.2（3.8-8.7）。幽门螺杆菌复发率在拉丁美洲是显著的，并且具有地理差异，但根据目前的文献考虑到大规模干预试验是可以接受的。有必要在拉丁美洲进行进一步的研究，以评估拟议的根除计划的效力、成本效益和潜在的不良后果。
To estimate Helicobacter pylori (H. pylori) recurrence rate in Latin America, a region with a significant H. pylori prevalence and gastric cancer burden. 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. 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). 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.