The role of Helicobacter pylori eradication in the management of gastro-esophageal reflux disease (GERD) is unclear.
In this study, physicians from Hong Kong, China, hypothesized that H. pylori eradication leads to worsened control of reflux disease.
The physicians recruited 236 consecutive patients with weekly reflux symptoms for endoscopy and symptom evaluation.
They enrolled patients in the study if they had H. pylori infection and required long term acid suppressants.
Of the 236 patients, 48% were positive for H. pylori. The physicians included 104 patients in the intention to treat analysis
Eligible patients were randomly assigned to receive omeprazole triple therapy (HpE group, n = 53) or omeprazole with placebo antibiotics (Hp+ group, n = 51) for 1 week.
Patients received omeprazole (20 mg daily for 8 weeks) for the healing of esophagitis and symptom relief. This was followed by a maintenance dose of 10 mg daily for up to 12 months.
The team set the primary study end point as the probability of treatment failure within 12 months. This was defined as incomplete resolution of symptoms or esophagitis during the initial treatment phase, or the relapse of symptoms and esophagitis during the maintenance phase.
Predictors of treatment failure were determined by Cox’s proportional hazards model.
|30% of patients had erosive esophagitis at baseline.|
The team determined that 30% of patients had erosive esophagitis at baseline.
H. pylori was eradicated in 98% of the HpE group and in 3.9% of the Hp+ group.
The physicians determined that 28% of patients in the HpE group and 16% of patients in the Hp+ group had treatment failure.
Furthermore, the 12 month probability of treatment failure was 43% in the HpE group and 21% in the Hp+ group.
Once adjustments were made for age, sex, erosive esophagitis, hiatus hernia, degree of gastritis, and severity of symptoms at baseline, H. pylori eradication was found to be the only predictor of treatment failure.
Dr Wu's team concluded, "H. pylori eradication leads to more resilient GERD".