Gastroesophageal reflux before and after Helicobacter pylori eradication. a prospective study using ambulatory 24-h esophageal pH monitoring

Abstract

The aim of this study was to assess prevalence of GERD before and after Helicobacter pylori (HP) eradication utilizing 24-h esophageal pH/manometry studies. Helicobacter pylori status was confirmed by the Campylobacter like organism test. Those testing positive underwent 24-h pH/manometry followed by HP eradication therapy and urea breath test. Patients were followed up at 6 months and then at 1 year when they underwent a repeat 24-h pH/manometry. Twenty patients, 10 with non-ulcer dyspepsia (NUD) and 10 with duodenal ulcer (DU) were enrolled, though only 10 patients attended for a repeat 24-h pH/manometry study. The patients were well matched, though patients with NUD had a significantly higher symptom score at entry compared with the DU group (8.5 vs 5.7, P < 0.05). The pH and esophageal manometry data were similar in the two groups. Overall nine patients (45%; DU = 5, NUD = 4) had evidence of GERD prior to HP eradication and it persisted one year after cure of the infection. The reflux disease occurred in the presence of normal LES pressure (mean 15.6 +/- 3.3 mmHg). New onset GERD was uncommon after cure of HP infection, occurring in only one patient with NUD. Overall HP eradication had no impact on percentage of time pH < 4 (4.69 +/- 3 vs 4.79 +/- 3), episodes > 5 min (9.8 +/- 16 vs 15.5 +/- 25.3) and Johnson DeMeester Score (16.8 +/- 7.5 vs 26.8 +/- 18). In addition successful cure of HP produced no significant changes in LES pressure (17.9 +/- 3.8 mmHg vs 19.3 +/- 4.6 mmHg), and other esophageal manometry data. Half of HP-positive patients with NUD and DU have evidence of GERD before HP eradication. This persists after successful cure of the infection. New onset GERD occurs very uncommonly one year after HP eradication.

Erosive esophagitis in the Philippines: A comparison between two time periods

“…The prevalence of H. pylori and PUD in our center has likewise declined significantly over the past decade, 27 with a concomitant increase in EE prevalence as seen in this study. However, the relationship between EE and H. pylori appears to be purely incidental as recent reports have disproved any real associations between the two 28,29 …”

Helicobacter pylori Infection Has No Impact on Manometric And pH-Metric Findings in Adolescents and Young Adults with Gastroesophageal Reflux and Antral Gastritis: Eradication Results to no Significant Clinical Improvement

“…Verma et al 24 found no significant correlation between the motility indexes and esophageal acid exposure in patients with GERD after eradication. Guliter and Kandilci studied 18 adult patients with GERD and Hp-gastritis using 24-hour pH-metry and static esophageal manometry.…”

Evaluation of gastric emptying by electrogastrography and ultrasonography in gastroesophageal reflux disease

“…Causative factors of GERD are considered to include reduced peristaltic activities of the esophagus and stomach, relaxation of the LES muscle, increased abdominal pressure, increased gastric acid secretion, and increased food intake 1–7 . Although there have been several studies on the gastric motility in GERD patients using EGG, 2,15–19 gastric motility has not been evaluated according to the severity of GERD or the presence of hiatal hernia.…”

“…was reduced in EGG in the GERD patients regardless of the Los Angeles grade, and a reduction in the motility of the gastrointestinal tract alone was considered to suggest GERD even in patients with no endoscopic abnormality in the upper gastrointestinal tract. Also, while the primary symptoms of GERD are heartburn and acid belching, symptoms similar to those of angina pectoris such as generalized chest pain, symptoms suggestive of respiratory disorders such as bronchial asthma and chronic cough, and otolaryngological disease‐like symptoms such as pharyngeal discomfort and hoarseness may also be caused by GERD 1–7 . EGG findings are considered to be useful for the diagnosis in such cases.…”

“…Reduced gastric motility, hiatal hernia, and obesity have been reported as causes of gastroesophageal reflux disease (GERD) 1,2 . These conditions are considered to predispose individuals without Helicobacter pylori infection to GERD, but not individuals with H. pylori infection, because acid secretion is reduced due to atrophy of the gastric mucosa by H. pylori infection 3 . In Japan, cases of esophagitis are increasing in tandem with the decrease in the number of individuals infected by H. pylori .…”