Gut 49:335-340 doi:10.1136/gut.49.3.335
  • Helicobacter pylori

Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oesophagitis compared with gastric cancer: analysis of 5732 Japanese subjects

  1. Y Yamajia,c,
  2. T Mitsushimab,c,
  3. H Ikumab,
  4. M Okamotoa,c,
  5. H Yoshidaa,
  6. T Kawabea,
  7. Y Shiratoria,
  8. K Saitob,
  9. K Yokouchic,
  10. M Omataa
  1. aDivision of Gastroenterology, Department of Internal Medicine, University of Tokyo, Tokyo, Japan, bDepartment of Gastroenterology, Kameda General Hospital, Kamogawa, Japan, cMakuhari Clinic, Chiba, Japan
  1. Dr Y Yamaji, Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.yamaji-tky{at}
  • Accepted 23 January 2001


BACKGROUND The relationship between Helicobacter pylori and reflux oesophagitis remains controversial.

AIMS To evaluate the relationship between H pylori and reflux oesophagitis in a large number of Japanese subjects.

SUBJECTS A total of 5732 consecutive Japanese subjects during a health screening were enrolled.

METHODS Gastrointestinal endoscopy was performed on all subjects. We simultaneously measured serum anti-H pylori antibody and pepsinogen as markers of H pylori infection together with gastric atrophy. The risk of reflux oesophagitis was evaluated in relation to these markers, and the results were compared with those of gastric cancer.

RESULTS Reflux oesophagitis was found in 108 subjects. Both positivity forH pylori antibody (adjusted odds ratio (OR) 0.67 (95% confidence interval 0.45–1.0)) and “low” pepsinogen indicating gastric atrophy (OR 0.35 (0.18–0.68)) were negatively associated with reflux oesophagitis. After subjects were classified into four groups based on positivity or negativity for H pylori antibody and “low” pepsinogen, the prevalence of reflux oesophagitis showed a decreasing trend as H pylori induced gastric atrophy became more severe. The risk of gastric cancer showed an increasing trend, exactly the opposite to that of reflux oesophagitis.

CONCLUSIONS Analysis of a large series of Japanese subjects revealed a decreasing prevalence of reflux oesophagitis in conjunction with progress of gastric atrophy induced by H pylori infection. This pattern was completely opposite to that of gastric cancer cases. A protective role of H pylori for reflux oesophagitis through the development of gastric atrophy has been suggested.


  • Abbreviations used in this paper:
    gastro-oesophageal reflux disease
    odds ratio