De novo erosive esophagitis in duodenal ulcer patients related to pre-existing reflux symptoms, smoking, and patient age, but not to Helicobacter pylori eradication: a one-year follow-up study

Abstract

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. Materials and methods. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers – 20-mg omeprazole b.i.d. for 4 weeks was administered. Results. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47–16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34–11.68), and smoking (OR, 3.17; 95% CI, 1.01–9.17). Conclusions. H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis.

Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis

“…Of these, 15 studies met the exclusion criteria (retrospective study design, single arm study, abstract only, and duplicated study) and eight were reviews, which were excluded. Finally, 27 full articles were assessed for eligibility ( Figure 1 ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. On categorization, 12 studies were assigned to Category A [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], 10 to Category B [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], and 5 to Category C [ 29 , 30 , 31 , 32 ,…”

“…We divided the studies into three categories: Category A were studies that compared the incidence rates of reflux esophagitis and reflux-related symptoms between patients receiving H. pylori eradication therapy (case) or placebo (control); Category B were studies that compared patients with successful eradication (case) or eradication failure and receipt of placebo (control, infection persisted); and Category C were studies that compared patients with successful eradication therapy (case) or eradication failure, receipt of placebo, and no-receipt of drug/placebo (control, infection persisted) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Author names, publication year, country where the study was conducted, follow-up period, number of patients, smoking habit, alcohol use, sex, age, eradication regimen, eradication rate, and incidence rates of endoscopic reflux esophagitis and reflux-related symptoms, such as heart burn, discomfort, and chest pain, before and after treatment were extracted from each study.…”

“…Considering the findings of systematic reviews and meta-analysis showing that H. pylori infection is inversely associated with GERD and reflux esophagitis [ 4 , 5 , 6 ], eradication therapy is also considered to increase the risk of GERD and reflux esophagitis and development of reflux-related symptoms. Many studies have evaluated the effects of H. pylori eradication on the development of GERD and reflux esophagitis and reflux-related symptoms, but results have been inconsistent and inconclusive [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. In their meta-analysis, Xie et al [ 34 ] reported a significantly increased risk of GERD in cohort studies of patients with successful eradication compared to those in whom eradication failed [risk ratio (RR): 1.70, 95% confidence interval (CI): 1.30–2.23] and a significantly increased risk in patients receiving eradication therapy compared with those receiving placebo (RR: 1.99, 95% CI: 1.23–3.22) in randomized control studies (RCT).…”

Meta-analysis

“…CagA + strains induce more extensive epithelial cell injuries [69,72] and secrete more proinflammatory cytokines (such as interleukin-8) [69,73] with more intense infiltration of the gastric mucosa by neutrophils and mononuclear cells [72,74] and more rapid development of atrophic gastritis [75] and concomitant changes in gastric secretion [70]. Using visualized images of Congo red chromoendoscopy, Sekine et al [76] found lnoue et al [42] Kim et al [43] Levine et al [44] Malfertheiner et al [10] McColl et al [45] Murai et al [46] Take et al [15] Tsukada et al [47] Total (95% CI) Bytzer et al [49] Hamada et al [14] Harvey et al [51] Jonaitis et al [52] Kim et al [54] Malfertheiner et al [10] Moayyedi et al [53] Nam et al [55] Ott et al [50] Vakil et al [11] Wu et al [56] Total (95% CI) that the acid-secreting mucosa in the fundus expanded in most cases with fundic atrophic gastritis after H. pylori eradication, which could be responsible for the increase or 'recovery' in acid secretion after the eradication.…”

Helicobacter pylori and Nonmalignant Diseases

“…Another article from Lithuania examined the relationship between H. pylori eradication in a cohort of duodenal ulcer patients and the development of erosive esophagitis (EE). EE developed in 8 of 70 (11.4%) successfully eradicated patients, in 9 of 49 (18.4%) unsuccessfully eradicated patients, and in 2 of 31 (6.5%) controls ( p > .05 comparing the groups), and the authors concluded that H. pylori eradication did not influence the incidence of EE over the 1‐year follow‐up period [37].…”