The effect of Helicobacter pylori eradication on gastro-oesophageal reflux

Background: Increased prevalence of oesophagitis has been reported followin g eradication of Helicobacter pylori. We hypothesized that H. pylori eradic ation might increase gastro-oesophageal acid reflux in patients with reflux oesophagitis. Methods: Twenty-five consecutive patients (13 male, 12 female) with H, pylo ri infection and reflux oesophagitis grade I (22 patients) or II (three pat ients) were enrolled; mean age 49.9 (range 33-75) years. Twenty-four hour i ntra-oesophageal pH recording was performed before and 12 weeks after eradi cation of H, pylori, which was achieved using bismuth subnitrate suspension 150 mg q.d.s., oxytetracycline 500 mg q.d.s, and metronidazole 400 mg t.d. s, for 10 days, Eradication was confirmed by C-14-urea breath test 12 weeks after completion of treatment. The patients did not receive acid-suppressi ve medication. Results: All patients had abnormal gastro-oesophageal reflux before anti-H. pylori treatment. After treatment, there was no significant change in the percentage of total time oesophageal pH < 4 (P = 0.46) in the 23 patients i n whom the infection had been cured. Nine of the cured patients had increas ed acid exposure, whereas 14 had decreased acid exposure. No significant ch ange in reflux symptom scores was found. There was no relationship between change in acid exposure and symptom improvement. Conclusions: Twelve weeks after H. pylori eradication there was no consiste nt change in gastro-oesophageal acid reflux in patients with mild or modera te reflux oesophagitis.