DECREASED PREVALENCE OF HELICOBACTER-PYLORI INFECTION IN GASTROESOPHAGEAL REFLUX DISEASE

Background. An increased incidence of reflux esophagitis has been repo rted after eradication of H. pylori in patients with duodenal ulcer. T o determine if H. pylori is associated with lower rates of esophagitis , we studied the prevalence of H. pylori infection in patients with an d without reflux esophagitis and a subgroup of patients with concomita nt peptic ulcer disease. Methods. Patients who underwent esophagogastr oduodenoscopy and had diagnostic testing for H. pylori over a 30-month period were studied. H. pylori infection was determined by rapid urea se testing, gastric histopathology, or serology. Reflux esophagitis wa s determined by endoscopic and/or histologic criteria. Results. Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagi tis. The prevalence of H. pylori infection in patients with reflux eso phagitis was 30.7%, compared with 42.0% in patients without esophagiti s (p = 0.039). The odds ratio for esophagitis risk with H. pylori infe ction was 0.61 (95% CI, 0.39-0.95). Neither patient age nor gender aff ected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of pat ients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09-0.73 ). Conclusions. Our study demonstrates that H, pylori infection is sig nificantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effe ct was more dramatic. Further study is required to confirm these findi ngs and elucidate mechanisms underlying possible beneficial effects of H. pylori.