Helicobacter pylori infection: Protection against Barrett's mucosa and neoplasia?

Background: Since Helicobacter pylori (Hp) infection provokes intestinal an d gastric metaplasia, the question arises whether the specialized metaplasi a (Barrett's mucosa (BM)) and dysplasia or carcinoma in Barrett's epitheliu m seen in gastro-oesophageal reflux disease (GORD) might not also be correl ated with Hp infection, or whether the latter offers protection against Bar rett's oesophagus and Barrett's adenocarcinoma. Patients: Gastric and oesop hageal biopsies obtained from a total of 2,201 patients were analysed retro spectively. 297 of these patients had GORD (age 53.5 +/- 13.4 years; m:f ra tio 2.1:1), 1,192 patients had BM (age 62.8 +/- 14.6 years; m:f 2.3:1) with or without neoplasia. 1,054 of these patients were diagnosed as having BM alone, 138 patients having BM neoplasia (high-grade dysplasia or adenocarci noma). Patients with BM and low-grade dysplasia were excluded from this stu dy because of the uncertainty in differentiating low-grade dysplasia from r egenerative epithelium. A total of 712 patients with non-ulcer dyspepsia (N UD; average age 40.0 +/- 16.1 years; m:f 0.3:1) served as a control group. Results:The percentage of Hp infection did not differ between patients with GORD with (53.3%)/without BM (51.4%) and neoplasia (47.8%), but is statist ically significantly lower than in patients with NUD (65.7%). Conclusion: O ur analysis shows that patients with GORD and Hp infection have no increase d risk for the development of BM or neoplasia in BM. Since Hp infection is significantly less frequent in GORD than in NUD patients, a protective effe ct of the Hp infection is a possibility worth discussing. Copyright (C) 200 0 S. Karger AG, Basel.