Different management for Helicobacter pylori positive and negative patients with gastro-oesophageal reflux disease?
Available evidence would suggest that Helicobacter pylori infection does not contribute to the pathogenesis of gastro-oesophageal reflux disease. The prevalence of H pylori infection in patients with reflux disease is no greater than that in control populations. There are some data suggesting that the organism has a protective role: patients with duodenal ulcers develop reflux disease after H pylori eradication, whereas in patients with oesophageal reflux those with H pylori infection have less severe reflux changes. There is also evidence indicating that the presence of H pylori augments the anti-secretory properties of both the H2 receptor antagonists and proton pump inhibitors (PPIs), suggesting that eradication therapy may not be beneficial. However, the considerable recent interest in the association between H pylori and reflux disease has largely been generated by studies outlining the interactions between H pylori infection and acid suppression in the long term. In H pylori positive patients, therapy with PPIs is associated with a proximal extension of the infection and its associated gastritis. In addition long term PPI therapy is reported to be associated with an accelerated development of atrophic gastritis, suggesting that H pylori should be diagnosed and treated. Although these latter findings in particular need confirmation, H pylori eradication therapy should be considered in this patient group, at least until there is evidence to the contrary.
Department of Gastroenterology, Meath/Adelaide Hospitals, Trinity College, Dublin, Ireland.
J M
JM
Lee
C A
CA
O'Morain
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000382:microbiology; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D016480:Helicobacter pylori; D006801:Humans; D006863:Hydrogen-Ion Concentration; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole