The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy

Background: Helicobacter pylori exaggerates the effect of acid suppressive drugs on intragastric pH. It is unknown whether this is relevant for the tr eatment of GERD. Aim: To compare oesophageal acid exposure and symptoms in H. pylori-negativ e and H. pylori-positive GERD patients during low and profound acid suppres sion. Methods: Barrett's oesophagus patients with gastro-oesophageal acid reflux were studied by 24-h oesophageal pH-metry at baseline and during randomized treatment with omeprazole 40 mg b.d. or ranitidine 150 mg b.d. a pylori st atus was determined by a serum IgG ELISA. Symptoms were scored on a four-gr aded scale. Results: Of 58 patients, 26 (14 H. pylori-negative, 12 H. pylori-positive) were randomized to omeprazole, 32 (16 H. pylori-negative, 16 H. pylori-posi tive) to ranitidine. At baseline, oesophageal acid exposure and symptoms di d not differ between H. pylori-negative and H. pylori-positive: mean time p roportion pH < 4 per 24 h was 16.1% (95% CI 11.5-23.2) in a pylori-negative , and 15.8% (11.3-21.4) in H. pylori-positive patients. Omeprazole treatmen t resulted in a decrease of acid reflux per 24 h from 23.4% (7.9-39.3) to 0 .0% (0.0-2.9) in a pylori-negative, and from 17.3% (8.9-38.8) to 0.1% (0.0- 1.7) in H. pylori-positive patients; ranitidine resulted in a decrease from 14.4% (10.5-18.5) to 9.3% (5.6-12.8) in a pylori-negative, and from 15.1% (9.8-21.0) to 9.0% (3.1-20.1) in H. pylori-positive patients, the differenc e between H. pylori-negative and H. pylori-positive patients being N.S. The re was no significant difference between H. pylori-negative and H. pylori-p ositive patients with respect to erect and supine acid reflux, or symptom s cores in both treatment groups. Conclusions: H. pylori infection does not influence oesophageal acid reflux and symptoms in patients with Barrett's oesophagus, either at baseline or during low as well as profound acid suppressive therapy. We conclude that t he dose of acid suppression does not have to be titrated upon a. pylori sta tus in GERD.