Positive Association Between Helicobacter pylori and Gastroesophageal Reflux Disease in Children

Abstract

Objectives-The role of Helicobacter pylori (H. pylori) in gastroesophageal reflux disease (GERD) remains controversial, particularly in children, since there are limited published data. Adult studies suggested that H. pylori infection may protect against GERD by causing atrophic gastritis, which leads to reduced gastric acid secretion. The objective of our study was to determine the role of H. pylori infection in the development of GERD in a pediatric population.Methods-A retrospective analysis of 420 patients (M:F = 214:206) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006 was conducted. Patient demographics, clinical indications for EGD and the prevalence of reflux esophagitis (RE), the biomarker for GERD, in two groups, H. pylori positive and H. pylori negative, were reviewed. The prevalence of RE in the H. pylori positive and H. pylori negative groups was further analyzed based on gender and age (< 1 yr, 1 -10 yrs, > 10 yrs). The mean age of the study population was 8.2 years (range 0 -20 yrs). The clinical indications for EGD were as follows: recurrent abdominal pain (n = 186, 44%), malabsorption (n = 80, 19%), persistent vomiting (n = 80, 19%), suspected eosinophilic gastrointestinal disorders (n = 63, 15%) and others such as upper GI bleeding or IBD surveillance (n = 11, 3%). Statistical analysis was performed by using Chi-square test, Fisher's exact test and multivariate logistical regression analysis.Results-Among the 420 patients, 16 patients (3.8%) were positive for H. pylori and 167 patients (39.8%) were found to have RE. Thirteen patients with H. pylori were found to have histologic evidence of RE. The prevalence of RE in the H. pylori positive population was 81.3% compared to 38.1% in the H. pylori negative population (p ≤ 0.05). There were no patients with H. pylori in the youngest age group. In the second age group (1-10 yrs), 100% of the H. pylori positive patients had RE while 44.6% of the H. pylori negative patients had RE (p ≤ 0.05). Both male and female patients with H. pylori had a higher prevalence of RE, 77.8% and 85.7% respectively. On a multivariate logistical regression, for the overall study cohort, H. pylori positive patients had an odds ratio of 5.79 of developing RE compared to H. pylori negative patients (p ≤ 0.05).Conclusions-Our study results indicate that there is a significantly higher prevalence of RE in an H. pylori-infected cohort independent of age or gender. The findings suggest that H. pylori infection in children is positively associated with RE.

Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry

“…Positive H. pylori status has been shown to be associated with a lower risk of EE [45]. One study showed that H. pylori eradication was associated with presence of EE [51]; other studies showed contradictory findings [52,53]. Our study though performed in a subset of patients considered acid related as well as motility parameters.…”

Prevalence of gastroesophageal reflux disease symptoms and related factors in patients with rheumatoid arthritis

“…(1) Some researchers have pointed out negative correlation of GERD with Helicobacter pylori infection, (34,35) while others reported no or positive correlation. (36–38) Since we did not perform endoscopy nor Helicobacter pylori examination in this study, it is unclear whether patients with these conditions were included in our study and whether they associated with GERD symptoms.…”

The role ofHelicobacter pyloriinfection in gastro‐oesophageal reflux in Iranian children

“…23 On the other hand, some studies have shown that H. pylori infection increases the risk of GORD in children. [24][25][26] Daugule et al showed that the prevalence of H. pylori is significantly higher in children with GORD than in children with hyperaemic gastropathy alone. 24 Studies in adults and children have shown that H. pylori-positive patients have a denser and more severe infection in the antrum.…”