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 25 May 2018

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Effect of H. pylori eradication on development of erosive esophagitis and GERD symptoms

Researchers in the latest issue of the American Journal of Gastroenterology find that H. pylori eradication in patients with duodenal ulcer disease, does not lead to the development of erosive esophagitis.

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In this study, researchers from the United States used a post hoc analysis of 8 double-blind prospective trials of Helicobacter pylori therapy in 1165 patients to asses the following:

  1. The development of erosive esophagitis.
  2. The development of gastroesophageal reflux disease (GERD) symptoms in patients without prior symptomatic or endoscopic GERD.
  3. And the worsening of GERD symptoms in patients with prior symptomatic GERD.

Patients with active or past duodenal ulcer and without baseline erosive esophagitis had end of study endoscopies 4 to 30 weeks after completion of therapy.
Erosive esophagitis developed in 4% of patients with successful eradication.
American Journal of Gastroenterology

A total of 533 patients had heartburn and regurgitation scores assessed at baseline and 4 weeks after end of therapy.

These patients were divided into two groups. The first group had no prior GERD symptoms (n = 127), while the second had prior GERD symptoms (n = 406).

The team assessed H. pylori at baseline and then at ≥ 4 weeks after therapy by rapid urease test, histology, and culture.

The researchers found that erosive esophagitis developed in 4% of patients with cure, compared with 3% of patients with persistent H. pylori (OR = 1.52).

In the longest study (28 to 30 week follow-up), esophagitis developed in 7% of patients with cure, compared with 7% persistent infection.

They also found that new GERD symptoms developed in 14% of patients with cure, versus 20% with persistent infection (OR = 0.66).

In addition, GERD worsened in 7% of patients with cure, versus 15% with persistent H. pylori (OR = 0.47).

Dr Loren Laine’s team concluded, “Our results do not support the hypothesis that H. pylori eradication in patients with duodenal ulcer disease leads to the development of erosive esophagitis.

Or to “The development of new symptomatic GERD, or worsening of symptoms in patients with pre-existing GERD”.

Am J Gastroenterol 2002; 97(12): 2992-7
10 December 2002

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