ArticlesHelicobacter pylori and symptomatic relapse of gastro-oesophageal reflux disease: a randomised controlled trial
Introduction
Gastro-oesophageal reflux disease (GORD) is a multifactorial disorder characterised by reflux of acidic gastric contents into the oesophagus leading to tissue damage and symptoms. Transient lower oesophageal-sphincter relaxation, a mechanically incompetent lower oesophageal sphincter,1 impaired motor function of the oesophageal body, and delayed gastric emptying2 could contribute to the disease.
The role of Helicobacter pylori in the pathogenesis of GORD is controversial. Some studies indicate a protective role,3, 4, 5, 6 whereas others fail to show different H pylori infection rates in patients with and without gastro-oesophageal reflux.7, 8, 9 Additionally, some researchers have reported an increased risk of developing GORD after eradication of H pylori in patients with duodenal ulcer,10 although others report an improvement of reflux symptoms after cure of infection.11
pH of gastric content is a major determinant of potential damage to the distal oesophageal mucosa. Hpylori has divergent effects on gastric secretory function dependent on intragastric distribution and severity of gastritis,12 and on strain of H pylori.6 Whereas antral predominant gastritis is associated with raised acid output, gastritis of the stomach body results in inhibition of acid secretion and might, therefore, prevent development of GORD.
Compared with studies13, 14 of patients with duodenal ulcers, data about the effects of H pylori eradication on relief and recurrence of symptoms in patients with established GORD are rare, are published only in abstract form,13 or lack a placebo control.14 Our aim was to investigate the effect of eradication of H pylori on relief of symptoms and the course of GORD.
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Patients
Between January, 1996, and July, 1999, we enrolled patients with symptoms of GORD. Initial investigations included an upper endoscopy with two biopsies each of the gastric antrum and body, and a 24-h measurement of oesophageal and gastric pH. All patients had had heartburn, acid regurgitation, or both for more than 4 weeks, and had either endoscopically proven reflux oesophagitis according to the modified Savary-Miller-Monnier classification (grade ≥I)15, 16 or a pathological reflux pattern
Results
70 of 129 patients screened were eligible for study inclusion. Data from the 58 patients who completed our study are presented. Figure 1 shows the trial profile and table 1 shows baseline characteristics of the 58 patients. There were more patients who had had GORD symptoms for more than 1 year in the Hpylori-positive group than in the Hpylori-eradicated group, otherwise all characteristics were similar between groups. 53 patients reported symptoms of heartburn and regurgitation, and four
Discussion
Results of studies with duodenal ulcer patients indicate that H pylori eradication substantially raises the risk of development of GORD.10 However, H pylori-positive patients with duodenal ulcer show a different pattern of gastric acid secretion to those without ulcer disease.2122 Furthermore, previous studies do not support the view that eradication of H pylori aggravates or precipitates GORD symptoms in ulcer patients and in those with functional dyspepsia.2324 Our results show that
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