Helicobacter pylori and gastroesophageal reflux disease: a case-control study.
BACKGROUND
Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict.


METHODS
We conducted a case-control study within the membership of a large integrated health-care system that compared GERD-free subjects with two groups: subjects with a physician-assigned GERD diagnosis and randomly selected members with self-described weekly GERD symptoms. Subjects completed interviews, GERD questionnaires, and antibody testing for H. pylori and its cagA protein.


RESULTS
Serologic data were available for 301 physician-assigned GERD patients, 81 general membership subjects with GERD symptoms, and 175 general membership subjects without GERD symptoms. Physician-assigned GERD patients were less likely to have H. pylori antibodies than GERD-free member controls (odds ratio (OR) = 0.27, 95% confidence interval (CI) 0.15-0.47); there was also an inverse association between H. pylori and GERD symptom severity (OR = 0.18, 95% CI 0.08-0.41; severe or very severe symptoms) and GERD frequency (OR = 0.18, 95% CI 0.09-0.38; for symptoms at least weekly). The association was stronger among persons with erosive GERD and was similar between H. pylori-positive subjects with and without cagA. There was no association among persons who were cagA positive, but H. pylori negative. Similar findings were found in analyses of the general membership with self-described GERD symptoms.


CONCLUSIONS
H. pylori antibody status was inversely associated with a GERD diagnosis and GERD symptoms compared with a general membership population.
Corley
Douglas A
DA
Division of Research, Kaiser Permanente, Oakland, California 94612-2304, USA. douglas.corley@kp.org
Kubo
Ai
A
Levin
T R
TR
Block
Gladys
G
Habel
Laurel
L
Rumore
Gregory
G
Quesenberry
Charles
C
Buffler
Patricia
P
Parsonnet
Julie
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000382:microbiology*; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000503:physiopathology; D016480:Helicobacter pylori / Q000254:growth & development / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D055815:Young Adult