title: Helicobacter pylori eradication may induce de novo, but transient and mild, reflux esophagitis: Prospective endoscopic evaluation.
abstract: OBJECTIVE
  The effect on reflux esophagitis of eradicating Helicobacter pylori is variable and not fully defined. We previously reported that in patients who have reflux esophagitis associated with duodenal ulcer, a significant improvement in the pre-existing reflux esophagitis occurred after H. pylori was eradicated. In the present study, we asked whether H. pylori eradication leads to de novo development of reflux esophagitis in peptic ulcer patients.
  
  
  METHODS
  Prospective post-eradication evaluations were conducted in 1195 H. pylori-positive patients with peptic ulcer diseases who were confirmed not to have reflux esophagitis by endoscopic examination before eradication therapy. After eradication therapy, endoscopy and a urea breath test were performed yearly.
  
  
  RESULTS
  A total of 1187 patients were followed for up to 10.0 years (a mean of 3.6 years). Reflux esophagitis developed in 279 of 1000 patients cured of infection and in 26 of 187 patients who had persistent infection (P < 0.0001, Fisher's exact test). The esophagitis was mild (Los Angeles grade A) in most patients, transient in approximately one-half, and rarely necessitated long-term medication for the condition. Cure of infection, alcohol consumption, younger age, and high body mass index were identified as significant factors for the risk of developing non-transient reflux esophagitis.
  
  
  CONCLUSIONS
  Cure of H. pylori infection may increase the risk of developing reflux esophagitis in patients with peptic ulcer, but the esophagitis is mostly mild and transient, and long-term medication is rarely required. Thus, H. pylori eradication therapy need not be withheld for fear of provoking reflux esophagitis.
authors.affiliation: Department of Internal Medicine, Fukuwatari Municipal Hospital, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Take
authors.forename: Motowo
authors.initials: M
authors.lastname: Mizuno
authors.forename: Kuniharu
authors.initials: K
authors.lastname: Ishiki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nagahara
authors.forename: Tomowo
authors.initials: T
authors.lastname: Yoshida
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokota
authors.forename: Keij
authors.initials: K
authors.lastname: Oguma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001944:Breath Tests; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000209:etiology / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D014508:Urea