Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole

Background & Aims: In previous studies an exaggerated effect of proton pump inhibitors (PPIs) on intragastric pH in Helicobacter pylori-infected patie nts was observed. Because healing and improvement of symptoms in patients w ith gastroesophageal reflux disease (GERD) is directly associated with an i ncrease of intragastric pH during treatment, we hypothesized that the respo nse to treatment with a PPI in patients with reflux esophagitis would be be tter in H. pylori-infected patients than in patients without H. pylori infe ction. Methods: We recruited 971 patients with endoscopically verified refl ux esophagitis grades II and III (Savary/ Miller). At study entry, H. pylor i status was assessed by a C-13-urea breath test and baseline characteristi cs were recorded. Physicians and patients were not notified about the resul ts of the breath test until completion of the study. All patients underwent treatment with pantoprazole, 40 mg orally once daily for 4 weeks. Healing was verified by endoscopy after 4 or 8 weeks of treatment. If the esophagit is had not completely healed at this time, treatment was continued for a fu rther 4-week period. Healing rates and symptom relief were compared for pat ients with and without Hi pylon infection. Results: The prevalence of H. py lori was 39.9% (95% confidence interval [CI], 36.9-42.9), and neither gende r, smoking, nor alcohol consumption were associated with the H. pylori infe ction (P > 0.4). The trial was completed by 846 patients without protocol v iolation. Overall healing rates of reflux esophagitis were 80.4% (95% CI, 7 7.7-83.1) and 93.6% (95% CI, 91.8-95.2) after 4 and 8 weeks, respectively. in H. pylori-positive patients, healing rates were significantly higher aft er 4 (86.6% vs. 76.3%; P = 0.0005) and 8 weeks (96.4% vs. 91.8%; P < 0.004) . Relief of symptoms after 4 weeks was also significantly (P < 0.05) better in H. pylori-infected patients than in uninfected patients. Conclusions: P atients with reflux esophagitis and H. pylori infection respond significant ly better than H. pylori-negative patients to the PPI pantoprazole.