Alimentary TractGastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole☆,☆☆,★,★★
Section snippets
Patients and methods
After written informed consent, 971 patients were recruited for the study. All patients were at least 18 years old and had, according to Savary and Miller,9 endoscopically confirmed reflux esophagitis of grades II (erosions that communicate but no circumferential lesions) or III (circumferential lesions). Patients were excluded from the trial if they had duodenal or gastric ulcers; Zollinger–Ellison syndrome; a history of esophageal surgery, pyloric stenoses, or malignancies; a history of
Demographic data
Nine hundred seventy-one patients fulfilled the entry criteria and were enrolled. The characteristics of H. pylori–positive and –negative patients are summarized in Table 1. Of the 971 patients in the intention-to-treat/safety population, 125 patients were excluded from the efficacy analysis (30 patients were excluded because of a violation of inclusion criteria, 35 patients withdrew from the study, 30 patients were excluded because of noncompliance with regard to the study medication, 26
Discussion
This study shows that in patients with grade II or grade III reflux esophagitis, healing of lesions and relief of symptoms during treatment with a standard dose of pantoprazole are significantly better in H. pylori–infected patients than in patients without H. pylori infection. The better response to treatment in H. pylori–infected patients is most likely due to a higher intragastric pH in H. pylori–infected patients. Indeed, previous studies in healthy volunteers and duodenal ulcer patients
Acknowledgements
The authors thank Dr. A. Zachmann for valuable help with the analyses of the data and the preparation of the manuscript, all study personnel who took part in the patient care and data collection in each study site, and those who were involved in packing the study drugs, monitoring the study, and processing the data.
References (22)
- et al.
Helicobacter pylori infection, reflux esophagitis, and atrophic gastritis: an unexplored triangle
Am J Gastroenterol
(1998) - et al.
Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis
Gastroenterology
(1997) - et al.
Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer
Gastroenterology
(1996) - et al.
The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease
Gastroenterology
(1998) - et al.
Helicobacter pylori in gastro-oesophageal reflux disease: causal agent, independent or protective factor?
Gut
(1997) - et al.
H. pylori, GERD and the efficacy of omeprazole therapy
Gastroenterology
(1997) - et al.
Helicobacter pylori and gastro-esophageal reflux disease: a prospective study
Ir J Med Sci
(1994) - et al.
H. pylori related increase in omeprazole (ome) effect is associated with ammonia production
Gastroenterology
(1996) - et al.
Appropriate acid suppression for the management of gastro-esophageal reflux disease
Digestion
(1992) - et al.
Der Ösophagus—Lehrbuch und endoskopischer Atlas
(1977)
Simplified single sample 13carbon urea breath test for Helicobacter pylori: comparison with histology, culture and ELISA serology
Gut
Cited by (208)
Vonoprazan Versus Lansoprazole for Healing and Maintenance of Healing of Erosive Esophagitis: A Randomized Trial
2023, GastroenterologyCitation Excerpt :Second, patients with H pylori infection were excluded from our study, but not the Asian studies cited. PPIs have greater efficacy in individuals with vs those without H pylori infection.26,27 A prior randomized trial from Japan found maintenance of healing at 24 weeks with vonoprazan, 20 mg, vonoprazan, 10 mg, and lansoprazole, 15 mg, to be 98%, 95%, and 83%,22 respectively, compared with our rates of 81%, 79%, and 72%, respectively.
Gastroesophageal reflux disease and the role of Helicobacter pylori
2022, Esophageal Disease and the Role of the MicrobiomeContributions From Gastroenterology: Acid Peptic Disorders, Barrett's Esophagus and Eosinophilic Esophagitis
2018, GastroenterologyCitation Excerpt :Vicari et al4 demonstrated an increased prevalence of CagA+ H pylori strains in the spectrum of GERD, and particularly in individuals with interleukin (IL)-1β and IL-1RN polymorphism,5 risk alleles predictive of more severe H pylori gastritis clinical outcome. However, several studies reported the negative association between H pylori and GERD,6,7 thus raising the question as to whether H pylori is positively or negatively correlated with GERD. The answer may depend on the location of infection.
Medical treatment versus surgery for treatment of gastroesophageal reflux disease
2015, Techniques in Gastrointestinal EndoscopyThe Evolving Challenges of Helicobacter pylori Disease, Diagnostics, and Treatment, Part I
2013, Clinical Microbiology NewsletterShort and long-term PPI treatment for GERD. Do we need more-potent anti-secretory drugs?
2010, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :This may explain the recovery of gastric acid secretion after eradication [104,105]. Several studies have reported better symptom control in H. pylori-positive than H. pylori-negative subjects [106] However, other trials observed no differences according to H. pylori status [107]. In summary, the impact of H. pylori on PPI efficacy in GERD seems very limited (if any).
- ☆
Supported by Byk Gulden, Konstanz, Germany.
- ☆☆
Address requests for reprints to: Gerald Holtmann, M.D., Department of Gastroenterology and Hepatology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. e-mail: [email protected]; fax: (49) 201-723-5970.
- ★
Kendle/GMI, Germany was responsible for monitoring at the study sites, data collection, and source data verification.
- ★★
The following persons also participated in the study (in alphabetic order): Achim A, Iserlohn; Adami B, Alzey; Adlkofer M, Berlin; Affani M, Bad Driburg; Aldenhoff D, Kamp-Lintfort; Apelt T, Neubiberg; Aßmus D, Nürnberg; Auchter K-H, Aalen-Wassersalfingen; Bach G, Karlsruhe; Bahlmann E, Morsbach; Bartfeld K-P, Henstedt-Ulzburg; Bayer H, Hamburg; Bechtel HE, Berlin; Bechtler H-J, Frankenthal; Beckmann B, Rochlitz; Beder E, Naumburg; Besch J, Neunkirchen; Biedermann A, Blankenhain; Bierbaum C, Hoyerswerda; Birke N, Saarbrücken; Bornscheuer V, Kassel; Braun K, Neubrandenburg; Bruns H, Lathen; Busch D, Salzkotten; Caspari J, Neuss; Christ J, Worbis; Dames J, Eschershausen; Deutscher R, Demmin; Dietz A, Ludwigsfelde; Döbbeler R, Brilon; Donecker R, Heringen; Döppenschmidt H, Germersheim; Döse H-J, Neumünster; Drost D, Bad Brückenau; Eisenbach T, Leverkusen-Schlebusch; Elsel W, Zwickau; Fabian-Krause J, Bad Tölz; Fante B, Dingolfing; Feinauer B, Mühlacker; Feyerabend H, Hagen; Fink R-R, Freising; Franke G-R, Dinkelsbühl; Frasch W, Viersen; Fricke U, Hemer; Fries J, Viernheim; Gabriel F, Düsseldorf; Glatzel C, Ludwigshafen/Oggersh; Glück W, Immenstadt; Gockel B, Dortmund; Goes R, Ditzingen; Groeneveld G, Fürth; Grosse W, Potsdam; Grothoff M, Ahlen; Güldütuna S, Frankfurt; Hagel H-J, Schwabach; Haimerl R, Simbach a. Inn; Hampel M, Schwedt; Hartl J, Nittenau; Hartmann H, Berlin; Heptner G, Dresden; Hering R, Baesweiler; Hoffmann N, Schweinfurt; Hust D, Kusel; Jakobeit C, Radevormwald; Janz R, Bergkamen; Jentzen F, Kiel; Jerwan-Keim R, Dietzenbach; Kaspari S, Lüneburg; Kirchhof M, Hamburg; Klein D, Köln; Kluge F, Freiburg; Knüpfer C, Wittenberg; Kohler B, Bühl; Kölbel W, Husum; König I, Bautzen; Koppenhöfer H, Walldorf; Kosmowski J, Frankfurt; Kraus H, Würselen; Kriszeleit H-J, Oberursel; Kühn A, Cottbus; Künzlen C, Bietigheim-Bissingen; Labitzke A, Reichenbach; Lange I, Vöhringen; Lange H, Bad Ems; Lautenschütz B, Germering; Leischik C, Köln-Weidenpesch; Lichtenstein A, Aachen; Linde B, Gera; Lohr E, Essen; Mackenroth T, Lübeck; Marheineke D, Neuwied; Marx W, Elmshorn; Mayr P, Stockach; Mayr-Städt J, Lohr a. M.; Mbamba H, Warstein; Mühlhausen U, Cuxhaven; Müller F, Arnsdorf; Müller H, Brandenburg; Nalbach B, Steinheim; Oehler R, Herford; Offermann M, Ahlen; Ott B, Remscheid; Panijel M, Frankfurt; Pape S, Paderborn-Kernstadt; Pfaff RKE, Gießen; Pietzsch T, Bochum; Pingel B, Niederstetten; Plass H, Nürnberg; Pustlauk U, Meinerzhagen; Raabe A, Berlin; Rachel T, Rastatt; Rehs H-U, Berlin; Reinicke A, Schwetzingen; Riddermann T, Marl; Rogalli A, Bensheim; Sabarstinski G, Marl; Schäfer B, Bochum; Schattenberg J, Wiesbaden; Schmidt H, Büdelsdorf; Schulz W, Halberstadt; Schweizer B, Stuttgart; Sehland D, Rostock; Simon T, München; Stock H, Pinneberg; Stölzle L, Traunstein; Thiemann R, Forchheim; Tibroni T, Coesfeld; Trabold G, Wernau; Türck I, Stuttgart; Uhlig K, Berlin; Vogl P, Osterhofen; Völler T, Storkow; Wagner T, Rostock; Walker H, Wangen; Wegner D, Leipzig; Wehnert J, Dresden; Westphal R, Germersheim; Weylandt J, Pinneberg; Wiesenhaken U, Leipzig; Wiest G, Nürnberg; Woywod G, Warendorf; Zäh W-D, Reutlingen; Zimmer E, Merzig-Hilbringen; Zimmerer E, Gerlingen; Zimmermann H, Hamburg; Zöllner K, Dippoldiswalde.