H. pylori infection decreases reflux esophagitis risk

MedWire News: Infection with Helicobacter pylori has a strong negative association with reflux esophagitis, and eradication of infection raises the prevalence of esophagitis to that of non-infected individuals, conclude South Korean investigators.

The association between H. pylori infection and gastroesophageal reflux disease remains a matter of debate, particularly as the majority of studies that have examined the link have been vulnerable to the confounding effect of variables associated with both reflux esophagitis and H. pylori infection.

To adjust for confounding factors, Il Ju Choi, from the National Cancer Center in Goyang, and colleagues enrolled 10,102 individuals from a comprehensive screening cohort, of whom 4007 were followed-up after a median of 2 years.

Overall, 490 of the original 10,102 participants had reflux esophagitis, 76.1% of whom had grade A, 22.7% had grade B, and 1.2% had grade C esophagitis. While there were no age differences between those with and without reflux esophagitis, esophagitis patients had a significantly higher body mass index than those without esophagitis (25.1 vs 23.9 kg/m²).

Among the 4971 individuals with H. pylori infection, the prevalence of reflux esophagitis was 6.4%, compared with 3.3% among those without H. pylori infection. On multivariate analysis, H. pylori infection was significantly negatively associated with reflux esophagitis, at an odds ratio of 0.42.

Other risks factors independently associated with reflux esophagitis were male gender, obesity, current smoking, current alcohol consumption, presence of hiatal hernia, and duodenal ulcer, the team reports in the American Journal Gastroenterology.

The prevalence of reflux esophagitis increased after successful eradication of H. pylori infection, at an odds ratio of 2.34 compared with individuals who had persistent infection. This was comparable to the odds ratio of reflux esophagitis among H. pylori infection-negative individuals versus persistently infected individuals, at 2.42.

Interestingly, gastroesophageal reflux disease symptoms were not associated with H. pylori infection or eradication.

The team writes: "Our findings suggest a strong negative association between reflux esophagitis and current H. pylori infection, after adjusting many confounding factors, which are the risk factors for both diseases in a large health-screening cohort.

"In addition, we found that the protective effect of H. pylori on reflux esophagitis disappeared after successful eradication."

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