The effect of Helicobacter pylori eradication on the development of gastro-esophageal reflux disease (GERD) is controversial.
Dr Vakil and colleagues determined the incidence of symptoms of reflux disease and of erosive esophagitis.
The investigative team also assessed the relationship to changes in histological gastritis.
The team studied 693 patients with non-ulcer dyspepsia over 12 months.
The investigators conducted 2 similar randomized placebo controlled trials of H pylori eradication in non-ulcer dyspepsia.
Symptoms were assessed using the validated Gastrointestinal Symptom Rating Scale during a 1-week run-in period, at 6 months and 12 months.
Endoscopy was performed at baseline to exclude patients with pathology.
In addition, the team performed endoscopy at 3 months, and 12 months to determine if esophagitis was present.
Gastric biopsies were scored using the modified Sydney Classification.
|Antrum-predominant gastritis is the most common form of gastritis in non-ulcer dyspepsia|
|Alimentary Pharmacology & Therapeutics|
The investigators randomized patients without predominant heartburn, esophagitis or ulcers at endoscopy to active treatment or placebo for 1 week.
There were 297 patients in the active group, which included omeprazole, amoxicillin and clarithromycin treatment.
A further 306 were in the placebo with omeprazole group.
The team found that the eradication rate was 82% in the active treatment group.
Antrum-predominant gastritis was more frequently found than corpus-predominant gastritis.
In patients with antrum-predominant gastritis, heartburn and regurgitation scores improved significantly 12 months after eradication.
The team observed that erosive esophagitis developed in 7% of patients in the eradication group vs 2% in the control group.
However, the investigators identified no significant difference when adjusted for esophagitis present at baseline.
Dr Vakil's team concludes, “Antrum-predominant gastritis is the most common pattern of gastritis seen in non-ulcer dyspepsia in Western populations.”
“Heartburn and regurgitation improve after eradication therapy or placebo in patients with non-ulcer dyspepsia, and the development of esophagitis is uncommon.”