Gastroesophageal Reflux Disease and Helicobacter pylori Infection


Salim A. Itani M.D. M.D.

Helicobacter Pylori
The discovery of H. pylori in gastric mucosa has changed the understanding and management of several gastroduodenal diseases. diseases.

.H. * Gastric adenocarcinoma.Pylori Benefits of the eradication of H. pylori have been reported from patients presenting : * Peptic ulcer disease. *Mucosa associated lymphoid tissue (MALT) lymphoma.

H. .Pylori &GERD However the improvement of symptoms in patients with GERD after the eradication of the bacteria remains controversial .

Is there any association between GERD and H.pylori on GERD ?   .Pylori infection ? 2-What is the reflection of presence of H.Questions  1.Pylori infection on GERD ? 3-What is the reflection of eradication of H.

 The role of H.pylori and GERD a confusing issue? Several studies showed a number of controversies .H. pylori infection in controversial. GERD remains controversial.  .

Pylori is decreasing .controversy  The controversy is important because GERD and its complications appear to be increasing . whereas H. .

-variable results in .Evidence for an association Clinical Studies : -mostly retrospective and not designed to address this relationship.Barrett¶s  .GERD .Esophagitis . -did not have effect of eradication on GERD as a primary outcome measure.

.pylori. «that this organism has a significant deleterious effect on any of the major pathophysiological factors in GERD. No convincing evidence to indicate: « a causal relationship between GERD and H.

that there exist NO clinically significant PHmetry.that differences in clinical or laboratory related GERD manifestations between H.2004) 20( (761).2004) .Pylori infected and non infected GERD patients.STUDY  In a prospective . and24hrs and24hrs PHmetry. 20(7) (761-768 ). (*)demonstrates .using excellent GERD quantifying measures including validated symptom severity scores.Pharma. Therapy.double blind study . endoscopy. (*)Fallone et al (Aliment.

Hypothesis The previous hypothesis that H. . pylori infection protects from the development of GERD is thought to be an erroneous concept recently.

H.   . The coexistence of peptic ulceration .Factors that influence the outcome of studies of this relationship   Prevalence of GERD and H.pylori.pylori. The pathological severity of GERD at the time of presentation and investigation. And the pathogenicity of the organism.

The acid load in stomach will decrease to Normal without a change in the parietal cell sensitivity to gastrin.U.Chronic antrum ±predominant gastritis Hypergastrinemia and increased secretion of acid leads to gastritis and Duodenal ulcer  In the presence of GERD .reflux esophagitis becomes more common.  .  By treating the D. common. and eradicating H.pylori.


esp.and that of Barrett¶s esophagus and its complications.  .pylori . those who are cagA positive leads to gastric atrophy and hypochlorhydria.  Corpus predominant gastritis.Corpus predominant gastritis Inverse relationship between the prevalence H.thus reducing the esophageal acid load and esophagitis.


gastritis.CagA+  The presence of the CagA+ gene in H.pylori has been implicated as a marker of more severe histological gastritis. CagA+ association with GERD has been evaluated in several studies with conflicting results. .

pylori reduces risk of Esophageal & gastric cardia adenocarcinoma. .CagA+ There is no evidence that infection with cagA+ strains of H.

CagA+ Strains. . esp.pylori infection .CagA+ Studies confirm the positive association between risk of distal gastric cancer and infection with H.

any exacerbation (esophagitis) will be minor and can be esophagitis) dealt with by PPI therapy.CorpusCorpus.predominating gastritis Eradication therapy of H.  In any event .  .  For GERD patients. there in no evidence that eradication exacerbates GERD symptomatology or pathology.pylori will lead to normal acid secretion.

in presence of the organism. . atrophic gastritis with the consequent risk of gastric cancer. as some studies have reported that these drugs induce . PPIs.Recommendations It has been recommended to eradicate H.pylori infection in those patients with GERD needing long term treatment with PPIs. cancer.

.Eradication Therapy When H.pylori eradication is Indicated in a particular patient. the concomitant diagnosis of GERD should not change our attitude.

Take Home Message There is. Pylori benefits the GERD patient. evidence to indicate that eradication of H. . indeed.


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