Summary

Heartburn is a common symptom affecting 21–44% of the adult population on a monthly basis. Oesophagitis is less common, affecting 2% of individuals.

Epidemiological studies have shown that patients with gastro-oesophageal reflux disease (GORD) have similar incidence rates of Helicobacter pylori infection as do controls. Some groups have reported that there is a lower incidence, deducing that infection does not cause, and in some way confers protection against GORD. Additional supportive evidence is available from reports of GORD development following successfulH pylori eradication. The mechanisms involved are complicated. Individuals with H pylori induced pangastritis and subsequent hypochlorhydria may be protected whereas those with an antral predominant gastritis, as in duodenal ulcer disease, with an increased acid output may be prone to development of GORD.

Recent evidence has linked H pyloriinfection with the development of inflammation of the gastric cardia—carditis. Reports are available which show that carditis is a frequent finding in patients with GORD. The incidence of both cardia and oesophageal carcinoma is increasing. The relation between GORD, carditis, intestinal metaplasia, and cardia carcinoma is unclear. Intestinal metaplasia may result from multifocal atrophic gastritis, linked to H pylori infection or from GORD and the development of Barrett’s oesophagus. Long term follow up studies will be required to assess the malignant potential of these histological entities and whether or not H pylori infection has an aetiological role.

Gastro-oesophageal reflux disease refers to the abnormal exposure of the oesophageal mucosa to gastric contents, resulting in a spectrum of conditions. Symptoms of heartburn or acid regurgitation affect 21–44% of the adult population on a monthly basis.1-3Oesophagitis is less prevalent, and is reported to occur in up to 2% of individuals.4 ,5 Symptoms have been shown to have a specificity of 85–95% and sensitivity of 6–39%.6Patients …