Helicobacter pylori is not associated with the manifestations of gastroesophageal reflux disease

Hypothesis: Helicobacter pylori is not associated with gastroesophageal ref lux disease and its complications, including adenocarcinoma of the esophagu s and the gastraesophageal, junction (GEJ). Design: Retrospective analysis. Setting: University tertiary referral center. Patients: Two hundred twenty-nine patients with symptoms suggestive of fore gut disease underwent esophageal manometry, 24-hour pH monitoring, and uppe r gastrointestinal tract endoscopy, with biopsy specimens obtained from the gastric antrum, the GEJ, and the distal esophagus. In these and in an addi tional 114 patients with adenocarcinoma of the esophagus and the GEJ, the p resence of H pylori was determined by Giemsa stain. The presence of gastroe sophageal reflux disease, defined by abnormal esophageal acid exposure, and its manifestations (carditis, erosive esophagitis, intestinal metaplasia l imited to the GEJ, Barrett esophagus, and adenocarcinoma of the esophagus a nd GEJ) were correlated with the presence of II pylori. Results: Helicobacter pylori was found on the biopsy specimens of the gastr ic antrum in 14.0% (32/229) of the patients with benign disease. It was not related to the features of gastroesophageal reflux disease, including abno rmal esophageal acid exposure, erosive esophagitis, or Barrett esophagus. T he presence of inflamed cardiac mucosa at the GEJ or carditis was inversely related to H pylori infection and strongly associated with increased esoph ageal acid exposure. There was no association between the presence of intes tinal metaplasia and H pylori infection. Helicobacter pylori was found in 2 2 (19.3%) of the 114 patients with esophageal adenocarcinoma, which was not different from the prevalence of H pylori in patients with benign disease. Conclusion: Helicobacter pylori plays no role in the pathogenesis of gastro esophageal reflux disease or its complications.