Recurrent symptoms and gastro-oesophageal reflux disease in patients with duodenal ulcer treated for Helicobacter pylori infection

Background: Eradication of Helicobacter pylori has been shown to prevent re lapse of endoscopically detected duodenal ulcers. There is controversy rega rding symptom improvement after therapy. Some studies have suggested that a substantial number of patients remain symptomatic after eradication therap y. Other studies suggest that gastro-oesophageal reflux disease (GERD) may develop as a result of H. pylori eradication. Aim: To determine the relationship between symptoms and H. pylori eradicati on and to determine whether H. pylori eradication results in symptoms or en doscopic findings of GERD. Methods: Two hundred and forty-two patients with endoscopically documented duodenal ulcer disease and evidence of H. pylori infection by rapid urease testing and histology were studied in four randomized, placebo-controlled, double-blind trials of H. pylori eradication therapy. All patients underwen t symptom assessment and endoscopy with biopsy before therapy and 1 and 6 m onths after completing therapy. The rapid urease test and histology were us ed to determine H. pylori status. Interviewers were blinded to H. pylori st atus after eradication and were unaware of the endoscopic findings (intervi ews were performed prior to repeat endoscopy). Results: The presence of epigastric pain was significantly associated with persistent H. pylori infection 1 month after therapy (odds ratio 2.3, 95% C I: 1.02-5.2; P=0.041), as was nausea (OR 7.1, 95% CI: 0.93-55.6; P=0.029). The presence of epigastric pain was significantly associated with ulcer rel apse at 6 months (OR 7.5, 95% CI: 3.6-15.7; P < 0.001) as was nausea (OR 5. 1, 95% CI: 1.7-16.0; P=0.002). Heartburn was not associated with eradicatio n of H. pylori or ulcer relapse. New onset reflux symptoms were reported by 17% (17 of 101 patients) at 6 months and were not significantly different in patients with (15%) and without (22%) persistent H. pylori infection (P= 0.47). Erosive oesophagitis was present at endoscopy in one of the 17 cases that developed new heartburn. Conclusions: One month after completion of therapy, the presence of epigast ric pain or nausea is associated with persistent infection and these sympto ms at 6 months are suggestive of duodenal ulcer relapse. The incidence of G ERD is not increased in patients who have eradication of H. pylori.