Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oesophagitis compared with gastric cancer: analysis of 5732 Japanese subjects

Background-The relationship between Helicobacter pylori and reflux oesophag itis remains controversial. Aims-To evaluate the relationship between H pylori and reflux oesophagitis in a large number of Japanese subjects. Subjects-A total of 5732 consecutive Japanese subjects during a health scre ening were enrolled. Methods-Gastrointestinal endoscopy was performed on all subjects. We simult aneously measured serum anti-H pylori antibody and pepsinogen as markers of H pylori infection together with gastric atrophy. The risk of reflux oesop hagitis was evaluated in relation to these markers, and the results were co mpared with those of gastric cancer. Results-Reflux oesophagitis was found in 108 subjects. Both positivity for H pylori antibody (adjusted odds ratio (OR) 0.67 (95% confidence interval 0 .45-1.0)) and "low" pepsinogen indicating gastric atrophy (OR 0.35 (0.18-0. 68)) were negatively associated with reflux oesophagitis. After subjects we re classified into four groups based on positivity or negativity for H pylo ri antibody and "low" pepsinogen, the prevalence of reflux oesophagitis sho wed a decreasing trend as H pylori induced gastric atrophy became more seve re. The risk of gastric cancer showed an increasing trend, exactly the oppo site to that of reflux oesophagitis. Conclusions-Analysis of a large series of Japanese subjects revealed a decr easing prevalence of reflux oesophagitis in conjunction with progress of ga stric atrophy induced by H pylori infection. This pattern was completely op posite to that of gastric cancer cases. A protective role of H pylori for r eflux oesophagitis through the development of gastric atrophy has been sugg ested.