Digestive Diseases News Summer 2010
Investigation Helps Clarify Association of H. pylori and GERD
Eradicating H. pylori bacteria infection does not increase the risk for gastroesophageal reflux disease (GERD), according to research findings reported by scientists at Canada’s McMaster University.
“We could not find any significant evidence that H. pylori eradication therapy increases the rate of GERD, but there was a numerical trend toward this in patients with peptic ulcer disease (PUD),” wrote Richard H. Hunt, M.D., professor, Department of Medicine, McMaster University, and co-authors in the May 2010 issue of The American Journal of Gastroenterology.
H. pylori infection is common in the United States: One in five people younger than 40 and half of those older than 60 have it, but most infected people do not develop PUD.
The Nobel Prize-winning 1983 discovery that H. pylori bacterial infection causes PUD led to efforts to prevent and treat peptic ulcers through eradication of H. pylori. Consequently, the prevalence of PUD has declined in countries with vigorous anti-H. pylori practices. During the same period, there has been an increase in rates of GERD, and this observation has led some researchers to speculate that H. pylori may, in some individuals, protect against development of GERD and its complications that can include Barrett’s esophagus and esophageal cancer.
To help clarify the relationship between H. pylori and GERD, the research group conducted a meta-analysis of recent research studies that provided data on the incidence of GERD in patients with H. pylori infection that had been eradicated and in patients with persistent infection.
Results of the meta-analysis suggest no significant overall association between H. pylori eradication and development of GERD. However, there was an increased likelihood of development of GERD among one subgroup of patients—those with PUD who had H. pylori eradicated were about twice as likely to develop GERD as were PUD patients with H. pylori infection that was allowed to persist.
In their analysis, the authors evaluated results of seven randomized control trials and five cohort studies published between January 1983 and February 2007.
The authors of the report point out that numerous other studies demonstrate a clear benefit to eradicating H. pylori in patients with PUD and that the possibility of avoiding GERD does not outweigh the benefits of treating PUD. “We do not recommend waiving therapy in patients for the sake of preventing GERD symptoms,” the researchers concluded.
The National Digestive Diseases Information Clearinghouse, an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases, has fact sheets and easy-to-read booklets about digestive disorders, including H. pylori and GERD. For more information and to obtain copies, visit www.digestive.niddk.nih.gov.
NIH Publication No. 10–4552