Review article:Helicobacter pyloriand gastro‐oesophageal reflux disease—clinical implications and management

Abstract

A significant proportion of patients with gastro‐oesophageal reflux disease (GERD) have Helicobacter pylori infection, but it is unclear whether or not H. pylori should be treated in this clinical setting. The aim of this review was to critically assess the relationship between H. pylori and GERD and its potential implications for the management of GERD. Data for this review were gathered from the following sources up to April 1998—the biomedical database M EDLINE, a detailed review of medical journals, and a review of abstracts submitted to relevant international meetings. On average, 40% of GERD patients carry H. pylori infection, with a reported infection prevalence ranging from 16% to 88%. To date, there has been no reported controlled trial of effective H. pylori therapy in GERD. GERD has been reported to develop de novo following the cure of H. pylori in peptic ulcer disease. In the presence of H. pylori, proton pump inhibitor therapy appears to accelerate the development of atrophic corpus gastritis, a potentially precancerous condition. Conversely, proton pump inhibitor therapy seems to become less effective after cure of H. pylori. The mechanisms underlying these important contrasting phenomena are poorly understood. The relationship between H. pylori and GERD is complex, and it is difficult to give definitive guidelines on the management of H. pylori infection in GERD. Controlled trials of H. pylori therapy in GERD are urgently needed, as well as further long‐term data on both the natural history of gastric histopathological changes in the H. pylori‐positive GERD patient treated with proton pump inhibitors, and the impact of H. pylori status on the clinical efficacy of antisecretory therapy. Pending these data, it is perhaps advisable to advocate cure of H. pylori in young patients with proton pump inhibitor‐dependent GERD who, in the absence of anti‐reflux surgery, are faced with the likelihood of long‐term medical therapy.

Comparison of Pantoprazole 20 mg to Ranitidine 150 mg b.i.d. in the Treatment of Mild Gastroesophageal Reflux Disease

“…Although the difference did not reach statistical significance, this result is in good agreement with findings of Holtmann et al [31]and two recent meta-analyses [32, 33]that demonstrated that PPI therapy is more effective in H. pylori -positive patients. However, the presence of H. pylori might lead to the development of atrophic gastritis, and eradication of the bacterium in certain groups of GERD patients has been recommended [34].…”

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

“…62 A review of 26 studies showed a rate of H. pylori infection in patients with GORD of 39% compared with 50% in controls 63. Similarly, the sequelae of GORD, such as Barrett's oesophagus and oesophageal adenocarcinoma, are also less common in infected individuals 64.…”

Management ofHelicobacter pyloriinfection—the Maastricht IV/ Florence Consensus Report

“…A review of 26 studies showed a rate of H pylori infection in patients with GORD of 39% compared with 50% in controls 19. Similarly, the sequelae of GORD, such as Barrett's oesophagus and oesophageal adenocarcinoma, are also less common in infected individuals 20.…”