Review article: the clinical influence of Helicobacter pylori in effectiveacid suppression - implications for the treatment of gastro-oesophageal reflux disease

The relationship between gastro-oesophageal reflux disease (GERD) and Helic obacter pylori is unclear. Recent data indicate that H, pylori probably exe rts a protective effect against GERD, In recent years, the interaction betw een H. pylori, proton pump inhibitors and GERD has been widely studied, Cur rently available proton pump inhibitors produce significantly higher intrag astric pH in H. pylori-positive patients than in those who are H. pylori ne gative, and this phenomenon may be clinically relevant. The mechanisms responsible for this difference in efficacy are not fully un derstood, although there are two major theories. Ammonia, produced by H. py lori, is able to neutralize gastric acid, and thus apparently increase the effect of acid suppressive agents (the 'ammonia theory'). The other theory is that decrease in acid output is due to the development of corpus gastrit is during treatment with a proton pump inhibitor (the 'gastritis theory'). Treatment strategies to overcome this lowered sensitivity to acid suppressi on are to increase the frequency/dose of a proton pump inhibitor or to add an Ha-receptor antagonist in the evening-but both have pharmaco-economic im plications. An agent that could provide adequate pH control regardless of H . pylori status would be highly beneficial in the treatment of GERD, and ma y also lower treatment costs.