Helicobacter pylori Is Not Associated With the Manifestations of Gastroesophageal Reflux Disease

Abstract

Helicobacter pylori is not associated with gastroesophageal reflux disease and its complications, including adenocarcinoma of the esophagus and the gastroesophageal junction (GEJ). Design: Retrospective analysis. Setting: University tertiary referral center. Patients: Two hundred twenty-nine patients with symptoms suggestive of foregut disease underwent esophageal manometry, 24-hour pH monitoring, and upper gastrointestinal tract endoscopy, with biopsy specimens obtained from the gastric antrum, the GEJ, and the distal esophagus. In these and in an additional 114 patients with adenocarcinoma of the esophagus and the GEJ, the presence of H pylori was determined by Giemsa stain. The presence of gastroesophageal reflux disease, defined by abnormal esophageal acid exposure, and its manifestations (carditis, erosive esophagitis, intestinal metaplasia limited to the GEJ, Barrett esophagus, and adenocarcinoma of the esophagus and GEJ) were correlated with the presence of H pylori. Results: Helicobacter pylori was found on the biopsy specimens of the gastric antrum in 14.0% (32/229) of the patients with benign disease. It was not related to the features of gastroesophageal reflux disease, including abnormal esophageal acid exposure, erosive esophagitis, or Barrett esophagus. The presence of inflamed cardiac mucosa at the GEJ or carditis was inversely related to H pylori infection and strongly associated with increased esophageal acid exposure. There was no association between the presence of intestinal metaplasia and H pylori infection. Helicobacter pylori was found in 22 (19.3%) of the 114 patients with esophageal adenocarcinoma, which was not different from the prevalence of H pylori in patients with benign disease. Conclusion: Helicobacter pylori plays no role in the pathogenesis of gastroesophageal reflux disease or its complications.

Epidemiology of Helicobacter pylori and gastric cancer

“…Negative relationship between H. pylori and gastric cardia or esophageal adenocarcinoma Several studies have shown that H. pylori, especially CagA-positive strains, exert a protective effect against gastric cardia and esophageal adenocarcinoma [94,95], although a few contradictory results have been obtained [96]. Inflammation provoked by H. pylori inhibits gastric secretion, and prevents gastroesophageal reflux disease (GERD) [97,98].…”

Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux

“…Subjects with esophageal pH of less than 4 for more than 4.4% of the registered time, and an acid score of more than 15 were classified as possessing abnormal esophageal acid exposure. 4 GERD patients were first analyzed as an entire group comprising those with stage II and stage III esophagitis according to the SavaryMiller classification, and then those with stage II esophagitis and stage III esophagitis were analyzed as independent subgroups. Statistical analysis was performed with the 2000 GraphStat statistical software (GraphPad Software, San Diego, CA, USA).…”

“…Recent reports demonstrate that H. pylori eradication therapy increases the prevalence of esophagitis due to reflux, and that the presence of HH is related to the development of this new reflux-caused esophagitis. 1,2 However, a negative association has also been reported between the infection caused by H. pylori and reflux esophagitis in older patients; 3 additionally, Oberg et al 4 show that H. pylori plays no role in GERD pathogenesis or its complications. On the other hand, little information is available concerning the combined relationship between H. pylori infection, HH, and GERD and the intrinsic behavior of the esophagus as manifested in the physiologic parameters of esophageal motility 5 and acid reflux demonstrated by 24-h pHmetry.…”

A clinical review on the pathology and management "Helicobacter pylori" infection.

“…53 According to endoscopic biopsy is necessary or not. Histologic evaluation, culture, polymerase chain reaction (PCR), and rapid urease tests are typically performed on tissue obtained at endoscopy.…”

“…A cost effective and reliable means of diagnosing active infection and confirming cure, such testing has a sensitivity and specificity comparable to those of other non invasive tests. 53 Questions remain regarding possible cross reactivity with other Helicobacter species existent in the guts, but definitive studies are lacking.…”