Review article: Helicobacter pylori and gastro-oesophageal reflux disease—clinical implications and management
Article first published online: 24 DEC 2001
Alimentary Pharmacology & Therapeutics
Volume 13, Issue 2, pages 117–127, February 1999
How to Cite
O’connor (1999), Review article: Helicobacter pylori and gastro-oesophageal reflux disease—clinical implications and management . Alimentary Pharmacology & Therapeutics, 13: 117–127. doi: 10.1046/j.1365-2036.1999.00460.x
- Issue published online: 24 DEC 2001
- Article first published online: 24 DEC 2001
A significant proportion of patients with gastro-oesophageal reflux disease (GERD) have Helicobacter pylori infection, but it is unclear whether or not H. pylori should be treated in this clinical setting. The aim of this review was to critically assess the relationship between H. pylori and GERD and its potential implications for the management of GERD. Data for this review were gathered from the following sources up to April 1998—the biomedical database M EDLINE, a detailed review of medical journals, and a review of abstracts submitted to relevant international meetings.
On average, 40% of GERD patients carry H. pylori infection, with a reported infection prevalence ranging from 16% to 88%. To date, there has been no reported controlled trial of effective H. pylori therapy in GERD. GERD has been reported to develop de novo following the cure of H. pylori in peptic ulcer disease.
In the presence of H. pylori, proton pump inhibitor therapy appears to accelerate the development of atrophic corpus gastritis, a potentially precancerous condition. Conversely, proton pump inhibitor therapy seems to become less effective after cure of H. pylori. The mechanisms underlying these important contrasting phenomena are poorly understood.
The relationship between H. pylori and GERD is complex, and it is difficult to give definitive guidelines on the management of H. pylori infection in GERD. Controlled trials of H. pylori therapy in GERD are urgently needed, as well as further long-term data on both the natural history of gastric histopathological changes in the H. pylori-positive GERD patient treated with proton pump inhibitors, and the impact of H. pylori status on the clinical efficacy of antisecretory therapy. Pending these data, it is perhaps advisable to advocate cure of H. pylori in young patients with proton pump inhibitor-dependent GERD who, in the absence of anti-reflux surgery, are faced with the likelihood of long-term medical therapy.