Dysfunction of oesophageal motility in Helicobacter pylori-infected patients with reflux oesophagitis.
BACKGROUND
Helicobacter pylori infection has been suggested to be protective against gastro-oesophageal reflux disease. However, a significant proportion of patients with gastro-oesophageal reflux disease are infected by H. pylori.


OBJECTIVE
To study oesophageal motor function in H. pylori-infected patients with reflux oesophagitis.


METHODS
Patients with erosive reflux oesophagitis were recruited prospectively for stationary oesophageal manometry and 24-h ambulatory oesophageal pH monitoring. H. pylori status was determined by biopsy urease test. Non-reflux volunteers were recruited as controls.


RESULTS
Seventy-four patients with erosive oesophagitis (34 H. pylori-positive, 40 H. pylori-negative) and 48 non-reflux patient controls (22 H. pylori-positive, 26 H. pylori-negative) were recruited. There was no difference in severity of oesophagitis (median grade, 1; P=0.53) or oesophageal acid exposure (total percentage time oesophageal pH < 4, 7.6% vs. 6.8%; P=0.57) between H. pylori-positive and H. pylori-negative groups. Compared to H. pylori-negative patients, H. pylori-positive patients had significantly lower basal lower oesophageal sphincter pressure (12.2 mmHg vs. 15.3 mmHg; P=0.03) and amplitude of distal peristalsis (56.9 mmHg vs. 68.4 mmHg; P=0.03). Ineffective oesophageal motility (14% vs. 7%; P=0.02) and failed oesophageal peristalsis were also significantly more prevalent in H. pylori-positive patients.


CONCLUSIONS
Among patients with a similar degree of reflux oesophagitis, H. pylori-infected patients have more severe oesophageal dysmotility and lower oesophageal sphincter dysfunction. Oesophageal motor dysfunction probably plays a dominant role in the development of gastro-oesophageal reflux disease in patients with H. pylori infection.
Wu
J C
JC
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. justinwu@ekno.com
Lai
A C
AC
Wong
S K
SK
Chan
F K
FK
Leung
W K
WK
Sung
J J
JJ
D000328:Adult; D000368:Aged; D004942:Esophagitis, Peptic / Q000382:microbiology / Q000503:physiopathology*; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000382:microbiology / Q000503:physiopathology*; D016481:Helicobacter Infections / Q000382:microbiology / Q000503:physiopathology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged