Symptomatic benefit 1-3 years after H-pylori eradication in ulcer patients: Impact of gastroesophageal reflux disease

OBJECTIVES: Eradication of Helicobacter pylori (H. pylori) infection marked ly reduces the recurrence of duodenal and Gastric ulcers. However, there is little information regarding its efficacy in resolving dyspeptic symptoms in ulcer patients. The primary aim of this study was to assess the effect o f eradicating H. pylori infection on dyspeptic symptoms in ulcer patients. The secondary aim was to identify predictors of symptomatic response to H. pylori eradication. METHODS: A total of 97 dyspeptic patients with active duodenal and/or gastr ic ulceration associated with H. pylori infection and unrelated to NSAID us e had the severity and character of their dyspeptic symptoms measured befor e and again 1-3 yr after H. pylori eradication therapy. RESULTS: Pretreatment, the median dyspepsia score was 12 (4-16). Posttreatm ent, 55% of those eradicated of H. pylori had resolution of dyspepsia (scor e <2) compared with 18% of these not eradicated of the infection (95% CI fo r difference, 11-62%). Of the ulcer patients 31% had symptoms and/or endosc opic evidence of coexisting gastroesophageal reflux disease (GERD at initia l presentation and this influenced the symptomatic response to eradication of H. pylori. Of the 22 patients with heartburn or acid reflux as the predo minant presenting symptom, but no endoscopic esophagitis, only 27% experien ced resolution of dyspepsia after H. pylori eradication, compared with 68% of the 59 without those as predominant symptoms (95% CI for difference, 18- 63%). Only one of the five patients with coexisting endoscopic esophagitis at initial presentation experienced resolution of dyspepsia after H. pylori eradication. Symptomatic benefit was unrelated to time lapsed since the in fection was eradicated. Only three of 50 subjects developed de novo GERD sy mptoms after eradication of H. pylori, whereas 21 of 36 subjects experience d resolution of GERD symptoms after eradication of the infection. CONCLUSIONS: A substantial proportion of ulcer patients have symptoms and/o r signs of coexisting GERD at initial presentation and this reduces the sym ptomatic benefit from H. pylori eradication. However, we have found no evid ence that eradicating H. pylori induces de novo GERD symptoms in ulcer pati ents.