Colonization with <i>cag</i>A-Positive <i>Helicobacter pylori</i> Strains Inversely Associated with Reflux Esophagitis and Barrett’s Esophagus

Abstract

Aim: The hypothesis that colonization with cagA⁺ Helicobacter pylori strains protects against the development of gastroesophageal reflux disease (GERD) and its complications is tested. Methods: Patients with reflux esophagitis and Barrett’s esophagus were studied. Antral biopsy specimens were obtained for detection of H. pylori. A serum sample was obtained for determination of IgG antibodies to H. pylori and to the CagA protein. Results: 736 patients were studied. 118 patients had reflux esophagitis, 36 had Barrett’s esophagus, 108 had hiatal hernia without signs of inflammation (the reflux group), and 20 patients had esophageal or stomach cancer. The remaining 454 patients had no signs of GERD. The 262 patients with reflux disease had a significantly lower prevalence of H. pylori (34.9%) than the 454 controls (54.6%; p < 0.001). Among 310 H. pylori-positive patients from whom serum was available, colonization with cagA⁺ strains was detected in 59% in the control group versus 35% in the reflux group (p < 0.001). Conclusion: Patients with reflux esophagitis and Barrett’s esophagus have a significantly lower prevalence of H. pylori colonization than controls, in particular of the cagA⁺ type. These data suggest that colonization with cagA⁺ H. pylori strains may be protective against the development of GERD

Randomised controlled trial of effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project

“…Acid reflux depends more on the integrity of the lower oesophageal sphincter, hence the insignificant effect of H pylori infection on reflux. Patients with severe reflux oesophagitis are less likely to have H pylori infection, [17][18][19][20][21][22][23][24][25][26] possibly because corpus gastritis caused by helicobacter infection limits maximum acid output in these patients, [27][28][29][30][31][32] thus protecting them against the more severe forms of reflux oesophagitis. Such people might theoretically be at risk of increased exposure of the lower oesophagus to acid after eradication of H pylori infection.…”

Prospective study on effect of Helicobacter pylori on gastroesophageal reflux disease

“…11 Most studies find no relation between H pylori infection and etiology of GERD. 12 While other studies have found a lower prevalence of H pylori infection in patients with reflux symptoms, suggesting a possible protective effect of this bacterial infection. 13 The relation between H pylori infection and GERD needs more study in order to find the effect of H pylori on GERD patients.…”

Análise das impressões digitais de DNA e de fatores de virulência de linhagens de Helicobacter pylori

“…Recentemente, alguns trabalhos mostram que a infecção pelo H. pylori poderia ter um efeito protetor contra a doença (17,18,33,45,57) . De modo complementar, mostrou-se que pacientes infectados por linhagens mais virulentas (cagA+, vacAs1) estariam inversamente associados com o desenvolvimento da doença.…”

“…De modo complementar, mostrou-se que pacientes infectados por linhagens mais virulentas (cagA+, vacAs1) estariam inversamente associados com o desenvolvimento da doença. Deste modo, pacientes infectado por tais linhagens seriam protegidos contra complicações decorrentes do refluxo ácido (17,33,45,57) . Algumas hipóteses têm sido propostas para explicar tal fenômeno.…”