Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma

OBJECTIVE: This study was undertaken to prospectively determine the prevale nce of gastric H. pylori infection in Barrett's esophagus and Barrett's com plicated by dysplasia or adenocarcinoma. METHODS: The prevalence of H. pylori was determined in Barrett's esophagus patients compared to a control population of patients with gastroesophageal reflux disease (GERD) only. All patients had a minimum of 10 gastric surve illance biopsies obtained. H. pylori colonization was determined upon the b asis of hematoxylin and eosin and use of a modified Giemsa and or Steiner's silver stain of all gastric biopsy specimens. RESULTS: Two hundred and eighty-nine Barrett's patients and 217 GERD contro l patients were included in the study. H. pylori was found in 95/289 (32.9% ) of the Barrett's patients, compared with 96/217 (44.2%) of the GERD contr ols (NS). Forty-seven of the Barrett's patients had low-grade dysplasia/ind efinite dysplasia, 14 high-grade dysplasia, and 20 Barrett's adenocarcinoma . When Barrett's was subgrouped according to absence of dysplasia, and pres ence of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma, H. py lori prevalence was found to be significantly less for patients with Barret t's high-grade dyslpasia (14.3%) and adenocarcinoma (15.0%) versus patients with GERD alone (44.2%), Barrett's alone (35.1%), or Barrett's with low-gr ade dysplasia (36.2%) (p = 0.016). This difference could not be explained b y differences between Barrett's esophagus patients infected with H. pylori and those who were not with respect to gender, smoking history, alcohol con sumption, use of proton pump inhibitor, or length of Barrett's mucosa. CONCLUSIONS: Barrett's high-grade dysplasia and adenocarcinoma are signific antly more prevalent in patients who are not infected with H. pylori. H. py lori appears to have a protective effect against the development of Barrett 's adenocarcinoma. (C) 2000 by Am. Cell. of Gastroenterology.