Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease -- results from a randomized trial programme.
BACKGROUND
Helicobacter pylori infection has been proposed as a protective factor against the development of gastro-oesophageal reflux disease.


OBJECTIVE
To study heartburn and endoscopic findings before and after H. pylori eradication therapy in patients with peptic ulcer disease.


METHODS
In a multicentre trial programme, patients (n = 1497) were randomized to the omeprazole triple therapy group or to the control group, and were followed for 1-6 months after treatment. Patients in whom the infection was eradicated were compared with those in whom infection persisted. The severity of heartburn was measured at baseline and at each return visit. Endoscopy was performed 6 months after therapy in two of the five studies.


RESULTS
In patients with duodenal ulcer, there was a significantly lower prevalence of heartburn after successful eradication of H. pylori relative to that after failed eradication (estimated odds ratio, 0.48). The reduction in the prevalence of heartburn in patients with gastric ulcer was independent of the post-treatment H. pylori status. In studies in which ulcer relapse was included in the model, this factor emerged as a significant factor for heartburn. The observed incidence of oesophagitis at the last visit was not influenced by H. pylori status.


CONCLUSIONS
Eradication of H. pylori in patients with peptic ulcer disease was associated with a reduced prevalence of heartburn. Prevention of ulcer relapse could be the true cause of this reduction.
Universitätsklinik Otto-von-Guericke, Magdeburg, Germany. peter.malfertheiner@medizin.uni-magdeburg.de
P
P
Malfertheiner
J
J
Dent
L
L
Zeijlon
P
P
Sipponen
S J O
SJ
Veldhuyzen Van Zanten
C-F
CF
Burman
T
T
Lind
M
M
Wrangstadh
E
E
BayerdOrffer
J
J
Lonovics
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000150:complications* / Q000382:microbiology; D004942:Esophagitis, Peptic / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006356:Heartburn / Q000209:etiology* / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D013276:Stomach Ulcer / Q000150:complications* / Q000382:microbiology
D000900:Anti-Bacterial Agents