A joint team from the Departments of Medicine and Therapeutics, and Surgery, at the Prince of Wales Hospital, Hong Kong, have carried out a study into the effect of Helicobacter pylori eradication on esophageal acid exposure and disease severity in patients with reflux esophagitis.
Patients with reflux esophagitis and H. pylori infection were recruited for 24-hour esophageal pH-metry studies.
They were then randomly assigned to receive either H. pylori eradication therapy (1-week omeprazole-based triple therapy, followed by 7-week omeprazole) or omeprazole alone (8-week omeprazole).
Endoscopy, pH monitoring and symptom assessment were repeated in both groups at 26 weeks and uninfected patients were also recruited as controls.
A total of 40 patients (25 H. pylori-positive and 15 uninfected) with erosive esophagitis were studied.
|Esophageal pH:- lower for longer in anti-H.pylori treated patients|
|Alimentary Pharmacology and Therapeutics|
Fourteen were randomized to receive treatment for H. pylori eradication and 11 to receive omeprazole alone.
Among the three groups, no difference was found before and after treatment (at 26 weeks) in the percentage of time the esophageal pH was less than 4.
However, the percentage of time the esophageal pH was lower than 2 and lower than 3 was significantly increased in patients receiving H. pylori eradication therapy.
In 3 patients (21%) in the group being administered such treatment, there was a worsening of their reflux esophagitis.
J. C. Y. Wu, lead author of the paper, said that the study showed, "H. pylori eradication can increase esophageal acid exposure and it may adversely affect the clinical course of reflux disease in a subset of patients."