FOLLOW-UP STRATEGIES IN HELICOBACTER-PYLORI INFECTION

Background: Helicobacter pylori is recognized as the most frequent cause of chronic gastritis and as an important contributing agent to gastric and duodenal ulcer disease. The striking improvement seen in ulcer disease when the infection is eradicated has led to a more complex therapeutic approach. It appears mandatory to control not only the healing of the lesions but also the therapeutic effect on the infection. Aim: Patients undergoing eradication therapy were followed up (1) to determine the success of the eradication therapy and (2) to monitor the patients for relapse or re-infection. Results: Follow-up strategies for controlling H. pylori status in gastroduodenal diseases were proposed. Patients with duodenal and gastric ulcer disease in whom eradication therapy is attempted should be followed up. The procedure for patients with non-ulcer dyspepsia and patients at risk of gastric neoplasia is still a matter of controversy. Endoscopy-based tests are indicated in the primary evaluation and short-term follow-up for controlling the disease and the infective status. Both endoscopy-based tests and the [C-13]-urea breath test are suitable for assessing the infective status following treatment. Once the disease is healed and infection eradicated, non-invasive methods like the [C-13]-urea breath test and serology are preferred for long-term follow-up. Eradication should be confirmed at least 4 weeks after the end of treatment. The timing for further follow-up investigations depends basically on the H. pylori associated-disease and on the symptomatic status. Proposals: Different short- and long-term follow-up strategies are proposed for H. pylori-infected patients based on the type and severity of the disease (complicated or non-complicated ulcer), success of the eradication therapy and symptomology.