The association between CagA status and the development of esophagitis after the eradication of Helicobacter pylori

BACKGROUND: Strains of Helicobacter pylori with the cytotoxine-associated g ene A (cagA) are linked to severe forms of gastroduodenal disease. Although eradication of H. pylori may predispose to the development of reflux esoph agitis, the effects of CagA status on risk of esophagitis after successful H. pylori treatment are not known. METHODS: We studied 50 consecutive patients without esophagitis in whom H. pylori was eradicated successfully. CagA status was determined by immunoblo tting sera from patients against H. pylori antigens. Patients underwent upp er gastrointestinal endoscopy before eradication and 6, 12, 18, and 24 mont hs after eradication or when reflux symptoms occurred. Biopsy specimens of the antrum and corpus were evaluated for gastritis before H. pylori eradica tion and at the end of the study. The sum of the scores for acute and chron ic inflammation (both measured on a 0 [absent] to 3 [severe] scale) compris ed the total gastritis severity score. RESULTS: In a multivariate proportional hazards regression analysis, positi ve CagA serology (hazard ratio [HR] = 10, 95% confidence interval [CI]: 1.3 to 81) and moderate-to-severe corpus gastritis (total severity score great er than or equal to4) before eradication (HR = 2.3, 95% CI: 1.2 to 6.1) wer e independent risk factors for the development of esophagitis after H. pylo ri eradication. CONCLUSION: Patients infected with strains of H. pylori that are cagA-posit ive are at increased risk of developing esophagitis after eradication of H. pylori. Am J Med. 2001;110:703-707. (C) 2001 by Excerpta Medica, Inc.