Helicobacter pylori and gastroesophageal reflux disease
- John E Pandolfino, MD
John E Pandolfino, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Helicobacter pylori is an important risk factor for the development of peptic ulcer disease, gastric adenocarcinoma, and primary B cell lymphoma of the stomach. A possible role for H. pylori in the pathogenesis of gastroesophageal reflux disease (GERD) has also been suggested in a growing number of studies. However, the link between GERD and H. pylori is complex.
This topic review will summarize the available evidence suggesting a role for H. pylori in GERD. The pathophysiology of GERD and the treatment of H. pylori are discussed separately. (See "Pathophysiology of reflux esophagitis" and "Treatment regimens for Helicobacter pylori".)
Suspicion of an interaction between H. pylori and gastroesophageal reflux disease (GERD) stems from epidemiologic data showing that as the prevalence of H. pylori decreased in Western societies, the prevalence of GERD and adenocarcinoma of the esophagus increased . This trend led several investigators to examine the prevalence of H. pylori in patients with GERD.
Several reports have suggested that H. pylori-positive patients were less likely to have GERD, and, when present, the severity of esophagitis was decreased compared with those who were H. pylori negative [2-4]. A lower prevalence of Barrett's metaplasia and esophageal adenocarcinoma has also been described in individuals who were H. pylori positive [5,6].
Some studies suggested that H. pylori strains positive for Cag A (strains strongly associated with the development of corpus gastritis) may be particularly protective against the development of esophageal adenocarcinoma [7-9]. Thus, the available data suggest that colonization with H. pylori, particularly Cag A strains, may be protective against the more severe forms of GERD. Unfortunately, Cag A positive strains have also been associated with gastric adenocarcinoma. (See "Association between Helicobacter pylori infection and gastrointestinal malignancy".)
- el-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut 1998; 43:327.
- Hackelsberger A, Schultze V, Gunther T, et al. Helicobacter pylori prevalence in reflux esophagitis: A case control study (abstract). Gastroenterology 1997; 112:A137.
- Shirota T, Kusano M, Kawamura O, et al. Helicobacter pylori infection correlates with severity of reflux esophagitis: with manometry findings. J Gastroenterol 1999; 34:553.
- Chung SJ, Lim SH, Choi J, et al. Helicobacter pylori Serology Inversely Correlated With the Risk and Severity of Reflux Esophagitis in Helicobacter pylori Endemic Area: A Matched Case-Control Study of 5,616 Health Check-Up Koreans. J Neurogastroenterol Motil 2011; 17:267.
- Wang C, Yuan Y, Hunt RH. Helicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis. Am J Gastroenterol 2009; 104:492.
- Fischbach LA, Graham DY, Kramer JR, et al. Association between Helicobacter pylori and Barrett's esophagus: a case-control study. Am J Gastroenterol 2014; 109:357.
- Weston AP, Badr AS, Topalovski M, et al. Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma. Am J Gastroenterol 2000; 95:387.
- Vicari JJ, Peek RM, Falk GW, et al. The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease. Gastroenterology 1998; 115:50.
- Vaezi MF, Falk GW, Peek RM, et al. CagA-positive strains of Helicobacter pylori may protect against Barrett's esophagus. Am J Gastroenterol 2000; 95:2206.
- el-Omar EM, Penman ID, Ardill JE, et al. Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease. Gastroenterology 1995; 109:681.
- Feldman M, Cryer B, Sammer D, et al. Influence of H. pylori infection on meal-stimulated gastric acid secretion and gastroesophageal acid reflux. Am J Physiol 1999; 277:G1159.
- Osawa H, Kita H, Ohnishi H, et al. Helicobacter pylori eradication induces marked increase in H+/K+-adenosine triphosphatase expression without altering parietal cell number in human gastric mucosa. Gut 2006; 55:152.
- Labenz J, Blum AL, Bayerdörffer E, et al. Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis. Gastroenterology 1997; 112:1442.
- McColl KE, Dickson A, El-Nujumi A, et al. Symptomatic benefit 1-3 years after H. pylori eradication in ulcer patients: impact of gastroesophageal reflux disease. Am J Gastroenterol 2000; 95:101.
- Vakil N, Hahn B, McSorley D. Recurrent symptoms and gastro-oesophageal reflux disease in patients with duodenal ulcer treated for Helicobacter pylori infection. Aliment Pharmacol Ther 2000; 14:45.
- Ishiki K, Mizuno M, Take S, et al. Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease. Clin Gastroenterol Hepatol 2004; 2:474.
- Laine L, Sugg J. Effect of Helicobacter pylori eradication on development of erosive esophagitis and gastroesophageal reflux disease symptoms: a post hoc analysis of eight double blind prospective studies. Am J Gastroenterol 2002; 97:2992.
- Raghunath AS, Hungin AP, Wooff D, Childs S. Systematic review: the effect of Helicobacter pylori and its eradication on gastro-oesophageal reflux disease in patients with duodenal ulcers or reflux oesophagitis. Aliment Pharmacol Ther 2004; 20:733.
- Wu JC, Sung JJ, Chan FK, et al. Helicobacter pylori infection is associated with milder gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2000; 14:427.
- Koike T, Ohara S, Sekine H, et al. Helicobacter pylori infection prevents erosive reflux oesophagitis by decreasing gastric acid secretion. Gut 2001; 49:330.
- Hamada H, Haruma K, Mihara M, et al. High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori: impacts of hiatal hernia and corpus gastritis. Aliment Pharmacol Ther 2000; 14:729.
- Iijima K, Ohara S, Sekine H, et al. Changes in gastric acid secretion assayed by endoscopic gastrin test before and after Helicobacter pylori eradication. Gut 2000; 46:20.
- Tefera S, Hatlebakk JG, Berstad A. The effect of Helicobacter pylori eradication on gastro-oesophageal reflux. Aliment Pharmacol Ther 1999; 13:915.
- Schwizer W, Thumshirn M, Dent J, et al. Helicobacter pylori and symptomatic relapse of gastro-oesophageal reflux disease: a randomised controlled trial. Lancet 2001; 357:1738.
- Moayyedi P, Bardhan C, Young L, et al. Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease. Gastroenterology 2001; 121:1120.
- Verdú EF, Armstrong D, Fraser R, et al. Effect of Helicobacter pylori status on intragastric pH during treatment with omeprazole. Gut 1995; 36:539.
- Giral A, Celikel CA, Ozdogan O, et al. Impact of Helicobacter pylori eradication on the anti-secretory efficacy of lansoprazole in gastroesophageal reflux disease patients. J Gastroenterol Hepatol 2005; 20:1886.
- Labenz J, Tillenburg B, Peitz U, et al. Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer. Gastroenterology 1996; 110:725.
- Chan FK, Sung JJ, Chung SC, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet 1997; 350:975.
- Vakil NB, Traxler BM, Levine D. Symptom response and healing of erosive esophagitis with proton-pump inhibitors in patients with Helicobacter pylori infection. Am J Gastroenterol 2004; 99:1437.
- Lind T, Havelund T, Carlsson R, et al. Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Scand J Gastroenterol 1997; 32:974.
- Holtmann G, Cain C, Malfertheiner P. Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole. Gastroenterology 1999; 117:11.
- Schenk BE, Kuipers EJ, Klinkenberg-Knol EC, et al. Helicobacter pylori and the efficacy of omeprazole therapy for gastroesophageal reflux disease. Am J Gastroenterol 1999; 94:884.
- Klinkenberg-Knol EC, Nelis F, Dent J, et al. Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 2000; 118:661.
- Gillen D, Wirz AA, Ardill JE, McColl KE. Rebound hypersecretion after omeprazole and its relation to on-treatment acid suppression and Helicobacter pylori status. Gastroenterology 1999; 116:239.
- Kuipers EJ, Lundell L, Klinkenberg-Knol EC, et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 1996; 334:1018.
- Kuipers EJ, Nelis GF, Klinkenberg-Knol EC, et al. Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 2004; 53:12.
- Yang HB, Sheu BS, Wang ST, et al. H. pylori eradication prevents the progression of gastric intestinal metaplasia in reflux esophagitis patients using long-term esomeprazole. Am J Gastroenterol 2009; 104:1642.
- Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772.
- PATHOPHYSIOLOGY OF GERD AS IT RELATES TO H. PYLORI
- Antrum-dominant gastritis
- Corpus-dominant and pangastritis
- H. PYLORI ERADICATION AND GASTROESOPHAGEAL REFLUX DISEASE
- Patients with duodenal ulcers
- Patients with corpus-dominant or pangastritis
- Patients with GERD
- Effect of H. pylori on PPI therapy
- - Theoretical risk of long-term PPI therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS