Original article
Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease

https://doi.org/10.1016/S1542-3565(04)00165-XGet rights and content

Abstract

Background & Aims: There has been significant controversy over the relationship between Helicobacter pylori infection and reflux esophagitis. We investigated the effects of eradicating H. pylori on the reflux esophagitis found in patients with peptic ulcers. Methods: Prospective posteradication evaluations were conducted yearly in 162 H. pylori-positive patients who had reflux esophagitis together with peptic ulcer disease (4 women and 158 men, mean age = 49.1 yr). The Los Angeles classification of the patients’ esophagitis was: grade A, 90; grade B, 63; and grade C, 9. The follow-up evaluations began 1 to 2 months after completion of the eradication treatment (mean time of follow-up = 22 mo), and consisted of endoscopy and an interview focusing on heartburn. Results: Six patients were withdrawn from the study because of adverse drug reactions or a failure to regularly keep their appointments. After eradication therapy, we observed endoscopically that reflux esophagitis had improved in 87 (55.8%) of the 156 patients. The improvement rate was significantly higher in patients cured of infection (60.8%) than in those with persistent H. pylori infection (38.9%) (P = 0.04). Body mass index (odds ratio = 0.86, 95% confidence interval [CI] = 0.76–0.97), cure of infection (3.68, 95% CI = 1.56–8.69), the absence of a hiatal hernia (3.90, 95% CI = 1.83–8.28), and an ulcer located in the duodenum (2.75, 95% CI = 1.33–5.70) were identified as significant independent factors for the improvement of reflux esophagitis. Conclusions: In patients with reflux esophagitis associated with duodenal ulcer, a significant improvement in pre-existing reflux esophagitis was noted after H. pylori eradication.

Section snippets

Patients

We screened 1484 consecutive patients with a peptic ulcer who visited the outpatient clinic of Nippon Kokan Fukuyama Hospital from June 1995 to March 2003. There were 173 women and 1311 men, with a mean age of 48.9 years (range, 16–83 yr). These patients were mostly male factory workers at JFE Steel Corporation, West Japan Works, Fukuyama, Japan. A total of 779 patients had a gastric ulcer, 625 patients had a duodenal ulcer, and 80 patients had both. Among them, we enrolled 162 patients (10.9%)

Results

Six patients were dropped from the study because of an adverse drug reaction (diarrhea in 1 patient) or failure to complete the follow-up evaluation (5 patients). A total of 156 patients completed eradication therapy. H. pylori infection was cured in 120 (76.9%) of the 156 patients. The background characteristics of these 156 patients are provided in Table 1.

After eradication therapy, an improvement of reflux esophagitis was observed endoscopically in 87 (55.8%, 95% confidence interval [CI] =

Discussion

In the present study, we showed endoscopic improvement or disappearance in pre-existing reflux esophagitis in a significant portion of the 156 peptic ulcer patients evaluated systematically after therapy for eradication of H. pylori. Although an improvement of reflux symptoms after H. pylori eradication has been reported by several investigators,15, 16, 17 we have shown further endoscopic improvement of esophagitis. Low body mass index, cured H. pylori infection, the absence of hiatal hernia,

Acknowledgements

The authors thank Drs. Tetsuji Okuno, Tsuyoshi Okamoto, Fumihiro Hamada, Hidehiko Ishioka, Hiromi Hamamoto, and Shinitirou Hori, and Masako Kataoka, Youko Hakoda, Yoshimi Itoh, Rumiko Suzuki, and Hideaki Inoue (Nippon Kokan Fukuyama Hospital) for their support; and Dr. William R. Brown (Denver Health Medical Center, Denver, Colorado) for his assistance in the preparation of this manuscript.

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