Helicobacter pylori eradication does not influence gastroesophageal reflux disease: a prospective, parallel, randomized, open-label, controlled trial

Abstract

-Context -Helicobacter pylori has been associated with worsening of gastroesophageal reflux disease (GERD). ObjectiveTo evaluate the effect of H. pylori eradication in GERD patients. Methods -We conducted a prospective, randomized, controlled trial performing symptom evaluation, endoscopy, histology, manometry and esophageal pH testing on GERD patients. Patients infected with H. pylori were randomized to: 1) eradication treatment plus proton pump inhibitors treatment, or 2) proton pump inhibitors alone. Patients not infected constituted a negative control group. After 3 months, patients were re-evaluated by symptom assessment, endoscopy, histology and manometry. Results -GERD treatment resulted in significantly higher lower esophageal sphincter pressure, as measured by mean expiratory pressure, in H. pylori negative patients. There was significantly lower proportion of hypotensive waves and significantly higher proportion of normotensive waves in non-eradicated patients. All symptom scores were significantly reduced in the post-treatment period compared to baseline, to values that were similar among the three groups, in the post-treatment period.

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).…”

Effect of H. pylori infection on gastrin, ghrelin, motilin, and gastroesophageal reflux

“…In these studies, the proposed primary mechanism by which H. pylori influences the pathogenesis of GERD depends on the modification of gastrin and gastric acid secretion. Gastrin is released by antral G cells, and it is often increased in H. pylori-infected adults (16,17). Depending on the anatomical region and the consequence of infection, the serum level of gastrin and its effect may vary.…”

Helicobacter pylori infection and extragastroduodenal diseases

“…[70] под-твердил обратную корреляцию между инфекцией H. pylori и АКП у жителей восточных и западных стран. Тем не менее остается неясным, может ли эрадикация микроорганизма приводить к прогрессированию клинической и эндоскопической картины ГЭРБ, так как результаты исследований в этом направлении про-тиворечивы [71,72].…”