Effect of Helicobacter pylori infection and its eradication on reflux esophagitis and reflux symptoms.
OBJECTIVE
We evaluated the association between current Helicobacter pylori infection and reflux esophagitis and the effect of H. pylori eradication on reflux esophagitis in a healthy screening population.


METHODS
A total of 10,102 subjects in a comprehensive screening cohort were enrolled, and 4,007 subjects had follow-up after a median of 2 years. Effects of H. pylori infection on reflux esophagitis were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis. We evaluated the change in prevalence of reflux esophagitis and reflux symptoms after H. pylori eradication vs. persistence.


RESULTS
The prevalence of reflux esophagitis (as classified by the Los Angeles system) was 4.9% (490/10,102). Whereas the prevalence of reflux esophagitis was 6.4% (319/4,971) in subjects without H. pylori infection, it was 3.3% (171/5,131) in subjects with infection (P<0.001). H. pylori infection had a strong negative association with reflux esophagitis in multivariate analysis (OR 0.42; 95% CI, 0.34-0.51). Compared with the prevalence of reflux esophagitis in the persistent infection group, the prevalence of reflux esophagitis increased after successful H. pylori eradication (OR 2.34; 95% CI, 1.45-3.76; P<0.001), which was comparable to that of the H. pylori-negative group (OR 2.42; 95% CI, 1.73-3.36; P<0.001). However, reflux symptoms had no association with H. pylori infection or eradication.


CONCLUSIONS
In a healthy screening population, H. pylori infection had a strong negative association with reflux esophagitis, but H. pylori eradication increased the prevalence of erosive esophagitis to the level of H. pylori-negative individuals. Long-term clinical significance of newly developed erosive esophagitis after H. pylori eradication should be evaluated prospectively.
Nam
Su Youn
SY
Department of Gastroenterology, National Cancer Center, Goyang, Korea.
Choi
Il Ju
IJ
Ryu
Kum Hei
KH
Kim
Byung Chang
BC
Kim
Chan Gyoo
CG
Nam
Byung-Ho
BH
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017291:Clarithromycin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004942:Esophagitis, Peptic / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D018579:Patient Selection; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D017291:Clarithromycin; D009853:Omeprazole