The relationship between Helicobacter pylori (H. pylori) infection and gastro-esophageal reflux disease (GERD) is complex. Since some studies have suggested that H. pylori eradication may result in an increased incidence of GERD in duodenal ulcer patients, there have been debates about the protective function of H. pylori infection on GERD. H. pylori-associated antral gastritis can induce increased gastric acid output via increasing gastrin secretion. Changes in gastric acid secretion depend on the distribution (e.g. antral, corpus or pangastritis) or severity of gastritis, not on H. pylori infection itself. Patients with H. pylori infection are at risk of developing gastric mucosal atrophy, and a cohort study suggested that long-term proton pump inhibitor therapy for GERD may accelerate this process. Therefore, it has been recommended that H. pylori should be treated in GERD patients in whom a long-term antisecretory therapy is planned. The previous hypothesis that 'H. pylori infection protects from the development of GERD' is thought to be an erroneous concept recently.
Gastritis/microbiology ; Gastroesophageal Reflux/drug therapy/*microbiology ; Helicobacter Infections/*complications/drug therapy ; *Helicobacter pylori ; Humans

OBJECTIVETo confirm whether eradication of H. pylori is associated with the occurrence of gastroesophageal reflux disease (GERD).

METHODSWe searched multiple medical databases for published randomized controlled trials (RCTs) from 2000 to 2012 comparing the incidence of GERD in adult patients receiving H. pylori treatment and those without treatment. The effects of H. pylori eradication were analyzed by calculating the pooled estimates for the number of new cases of GERD. Each racial subgroup of patients was analyzed using risk ratio (RR) by fixed effects models. The publication bias was assessed with funnel plot, Egger and Begg's test.

RESULTSSixteen eligible RCTs were finally included in the analysis. Statistically analysis suggested H. pylori eradication was significantly correlated with the occurrence of GERD (RR 1.89, 95% CI 1.50-2.40). Funnel plot, Egger or Begg's test revealed no publication bias.

CONCLUSIONH. pylori may have a positive effect on GERD especially in Asian patients and those with long-term follow-up, and eradication of H. pylori may cause GERD.

Gastroesophageal Reflux ; epidemiology ; etiology ; microbiology ; Helicobacter Infections ; drug therapy ; microbiology ; Helicobacter pylori ; Humans ; Randomized Controlled Trials as Topic

BACKGROUND/AIMS: The prevalence of gastroesophageal reflux disease (GERD) in Korea was believed to be low until now. Korea is now believed to be on the evolving stage of GERD in its' prevalence. The aims of this study were to evaluate the epidemiologic and clinicopathologic characteristics among the subgroups of GERD i.e. non-erosive GERD (NERD), erosive GERD (ERD) and Barrett's esophagus (BE), and the role of Helicobacter pylori (H. pylori) infection in the pathogenesis of GERD. METHODS: A total of 253 patients with typical symptoms of GERD who underwent EGD were enrolled from October 2002 to January 2004. Patients were grouped as NERD, ERD or BE based on the symptoms and endoscopic findings. BE was histologically confirmed if necessary. Various clinical parameters including the status of H. pylori infection were analyzed. RESULTS: Among 253 patients, 106 patients were classified as NERD while 116 and 31 patients were classified as ERD and BE group respectively. BE and ERD group showed no gender predilection while NERD showed female preponderance (2.31:1, p<0.05). NERD group were younger (49.57 y.o.) than BE (57.87 y.o.) and ERD (52.30 y.o.) group. About three quarters of the patients of erosive esophagitis were LA-A (74.2%) grade. This suggests the mild nature of erosive esophagitis in Korea. ERD showed significantly higher BMI (kg/m2) compared to NERD (p<0.05). Hiatal hernia was frequently associated with BE and ERD (p<0.05), but less frequently in NERD. Overall H. pylori positivity among GERD was significantly lower than the age and gender matched control group (p<0.05). CONCLUSIONS: Subgroups of GERD in Korea showed different epidemiologic and clinical characteristics. Lower rate of H. pylori infection among GERD group may reflect the protective role of H. pylori infection regarding GERD prevalence in Korea.
Aged ; Barrett Esophagus/diagnosis/drug therapy/microbiology ; Female ; Gastroesophageal Reflux/diagnosis/drug therapy/*microbiology ; Helicobacter Infections/*complications/drug therapy/epidemiology ; *Helicobacter pylori ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence

Proton pump inhibitors (PPIs) are commonly used to lessen symptoms in patients with gastroesophageal reflux disease (GERD). However, the effects of PPI therapy on the gastrointestinal microbiota in GERD patients remain unclear. We examined the association between the PPI usage and the microbiota present in gastric mucosal and fecal samples from GERD patients and healthy controls (HCs) using 16S rRNA gene sequencing. GERD patients taking PPIs were further divided into short-term and long-term PPI user groups. We showed that PPI administration lowered the relative bacterial diversity of the gastric microbiota in GERD patients. Compared to the non-PPI-user and HC groups, higher abundances of Planococcaceae, Oxalobacteraceae, and Sphingomonadaceae were found in the gastric microbiota from the PPI-user group. In addition, the Methylophilus genus was more highly abundant in the long-term PPI user group than in the short-term PPI-user group. Despite the absence of differences in alpha diversity, there were significant differences in the fecal bacterial composition of between GERD patients taking PPIs and those not taking PPIs. There was a higher abundance of Streptococcaceae, Veillonellaceae, Acidaminococcaceae, Micrococcaceae, and Flavobacteriaceae present in the fecal microbiota from the PPI-user group than those from the non-PPI-user and HC groups. Additionally, a significantly higher abundance of Ruminococcus was found in GERD patients on long-term PPI medication than that on short-term PPI medication. Our study indicates that PPI administration in patients with GERD has a significant effect on the abundance and structure of the gastric mucosal microbiota but only on the composition of the fecal microbiota.
Adult ; Aged ; Bacteria ; genetics ; isolation & purification ; Feces ; microbiology ; Female ; Gastric Mucosa ; microbiology ; Gastroesophageal Reflux ; drug therapy ; microbiology ; Gastrointestinal Microbiome ; drug effects ; Humans ; Male ; Microbiota ; Middle Aged ; Proton Pump Inhibitors ; therapeutic use ; RNA, Ribosomal, 16S ; genetics

BACKGROUNDHelicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy.

METHODSPatients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth-Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ2 test and t-test were used, respectively, for enumeration and measurement data.

RESULTSThere were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546).

CONCLUSIONSBased on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.

Adolescent ; Adult ; Aged ; Amoxicillin ; therapeutic use ; Esomeprazole ; therapeutic use ; Esophagitis, Peptic ; drug therapy ; etiology ; microbiology ; Female ; Gastroesophageal Reflux ; drug therapy ; etiology ; microbiology ; Helicobacter Infections ; complications ; drug therapy ; Helicobacter pylori ; drug effects ; pathogenicity ; Humans ; Male ; Middle Aged ; Tinidazole ; therapeutic use ; Young Adult

BACKGROUND/AIMS: The acid suppressive effect of omeprazole (OMP) is influenced by the metabolic capacity of gastric acid suppression, which is dependent on CYP2C19 polymorphism. The aim of this study was to determine the influence of CYP2C19 polymorphism and Helicobacter pylori (H. pylori) infection on the intragastric acid suppression of OMP. METHODS: Thirty one patients with gastroesophageal reflux disease were treated with a daily oral dose of 20 mg OMP for 28 days. Patients were genotyped for CYP2C19 polymorphism by polymerase chain reaction-restriction fragment length polymorphism and classified into three groups: homogenous extensive metabolizers (Ho-EMs), heterogenous extensive metabolizers (Ht-EMs) and poor metabolizer (PMs). H. pylori infection status were assessed before OMP treatment. Intragastric pH was monitored over twenty four-hours before (day 0) and after (day 29) the treatment with OMP. RESULTS: Twenty four-hour intragastric mean pH in the PMs group was significantly higher than those in Ho-EMs and Ht-EMs (5.3+/-1.3 vs. 2.8+/-0.6, 3.6+/-1.4) (p<0.005). Twenty four-hour intragastric mean pH after the administration of OMP in the H. pylori positive group was significantly higher than the H. pylori negative group (4.7+/-1.4 vs. 3.2+/-1.4) (p<0.001). There was no significant difference in acid suppressive activity of OMP between H. pylori positive and negative group according to CYP2C19 polymorphism. CONCLUSIONS: The acid suppressive effect of OMP on intragastric pH is dependent on CYP2C19 polymorphism and the H. pylori-infected status in patients with gastroesophageal reflux disease. H. pylori infection may play a role in enhancing the acid suppressive potential of OMP.
Adult ; Aryl Hydrocarbon Hydroxylases/*genetics ; Female ; Gastroesophageal Reflux/*drug therapy/genetics/microbiology ; Genotype ; Helicobacter Infections/*complications ; *Helicobacter pylori/isolation & purification ; Heterozygote ; Homozygote ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Omeprazole/administration & dosage/*therapeutic use ; *Polymorphism, Genetic ; Proton Pump Inhibitors/administration & dosage/*therapeutic use