The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy.
BACKGROUND
Helicobacter pylori exaggerates the effect of acid suppressive drugs on intragastric pH. It is unknown whether this is relevant for the treatment of GERD.


OBJECTIVE
To compare oesophageal acid exposure and symptoms in H. pylori-negative and H. pylori-positive GERD patients during low and profound acid suppression.


METHODS
Barrett's oesophagus patients with gastro- oesophageal acid reflux were studied by 24-h oesophageal pH-metry at baseline and during randomized treatment with omeprazole 40 mg b.d. or ranitidine 150 mg b.d. H. pylori status was determined by a serum IgG ELISA. Symptoms were scored on a four-graded scale.


RESULTS
Of 58 patients, 26 (14 H. pylori-negative, 12 H. pylori-positive) were randomized to omeprazole, 32 (16 H. pylori-negative, 16 H. pylori-positive) to ranitidine. At baseline, oesophageal acid exposure and symptoms did not differ between H. pylori-negative and H. pylori-positive: mean time proportion pH < 4 per 24 h was 16.1% (95% CI 11.5-23.2) in H. pylori-negative, and 15.8% (11.3-21.4) in H. pylori-positive patients. Omeprazole treatment resulted in a decrease of acid reflux per 24 h from 23.4% (7.9-39.3) to 0.0% (0.0-2.9) in H. pylori-negative, and from 17.3% (8.9-38.8) to 0.1% (0.0-1.7) in H. pylori-positive patients; ranitidine resulted in a decrease from 14.4% (10.5-18.5) to 9.3% (5.6-12.8) in H. pylori-negative, and from 15.1% (9.8-21.0) to 9.0% (3.1-20.1) in H. pylori-positive patients, the difference between H. pylori-negative and H. pylori-positive patients being N.S. There was no significant difference between H. pylori-negative and H. pylori-positive patients with respect to erect and supine acid reflux, or symptom scores in both treatment groups.


CONCLUSIONS
H. pylori infection does not influence oesophageal acid reflux and symptoms in patients with Barrett's oesophagus, either at baseline or during low as well as profound acid suppressive therapy. We conclude that the dose of acid suppression does not have to be titrated upon H. pylori status in GERD.
Peters
F T
FT
Department of Gastroenterology and Hepatology, University Hospital, Groningen, The Netherlands. f.t.m.peters@int.azg.nl
Kuipers
E J
EJ
Ganesh
S
S
Sluiter
W J
WJ
Klinkenberg-Knol
E C
EC
Lamers
C B
CB
Kleibeuker
J H
JH
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D004947:Esophagus / Q000187:drug effects* / Q000378:metabolism*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000494:pharmacology* / Q000627:therapeutic use; D012720:Severity of Illness Index
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D011899:Ranitidine; D009853:Omeprazole