High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori: impacts of hiatal hernia and corpus gastritis

Abstract

Eradication of H. pylori increased the prevalence of reflux oesophagitis in our patient group. The presence of hiatal hernia and corpus gastritis are closely related to the development of reflux oesophagitis after H. pylori eradication therapy.

Patterns of gastritis and the effect of eradicating Helicobacter pylori on gastro‐oesophageal reflux disease in Western patients with non‐ulcer dyspepsia

“…In one study from Japan, the cumulative prevalence of reflux oesophagitis after H. pylori eradication was 26% in patients with hiatal hernia, 8% in those without hiatal hernia, 33% in those with corpus atrophic gastritis and 13% in those without corpus atrophic gastritis. 5 A second finding in our study was that heartburn and regurgitation improve significantly after eradication therapy in patients with antrum-predominant gastritis. This is likely related to correction of the acid hypersecretion that occurs in these patients.…”

“…26 Two randomized controlled trials in 603 individuals reported on the development of oesophagitis. The development of reflux symptoms was uncommon, occurring in 6% of individuals undergoing eradication and 3% taking placebo (relative risk: 2, 95% CI: [1][2][3][4][5]. Differences between these studies are probably related to the small sample sizes, which make it difficult to detect an uncommon event, differences in the pattern of gastritis in the different populations studied and the lack of a randomized control group in others.…”

“…2 The incidence of symptomatic or endoscopic GERD developing in ulcer patients cured of the infection, however, has ranged widely in other reports. [3][4][5][6][7] The results of H. pylori eradication in non-ulcer dyspepsia have been mixed, with some studies showing no benefit and others demonstrating improvement in symptoms and prevention of future ulcer disease. [8][9][10] A recent meta-analysis demonstrated modest efficacy for H. pylori eradication in alleviating dyspeptic symptoms with a number needed to treat of 19. 11 A subsequent meta-analysis using individual patient data suggested that the benefit of eradication was similar whether patients with predominant epigastric pain or predominant heartburn were studied.…”

Neither genotype nor the gastric colonization site of Helicobacter pylori are predictive factors for the development of erosive esophagitis in patients with peptic ulcer disease, 1 year after eradication

“…A previous reflux disease hidden by peptic ulcer disease (28) , population differences (9) and methodological differences can justify these conflicting results.…”

“…The authors reported a higher rate of esophagitis in patients who had their H. pylori eradicated compared to the group in which the infection had continued. Following this first study, other trials were carried out, either confirming LABENZ' work (8,9,14) or reporting contradictory results (1,24,36,38,41,42,44) .…”