Patients with established gastro-esophageal reflux disease might benefit from Helicobacter pylori eradication

Authors John M. Moschos, George Kouklakis, Stergios Vradelis, Petros Zezos, Michael Pitiakoudis, Dimitrios Chatzopoulos, Christos Zavos, Jannis Kountouras.


Background The aim of this study was to investigate the effect of Helicobacter pylori (H. pylori) eradication in selected H. pylori-positive patients with a primary diagnosis of gastro-esophageal reflux disease (GERD) by using the 3-h postprandial esophageal pH monitoring.

Methods We recruited patients with erosive esophagitis at endoscopy and H. pylori infection at histology, successfully cured following eradication therapy; the selected H. pylori-positive patients had weekly reflux symptoms for at least six months and endoscopically established Grade A or B esophagitis. Twenty-nine eligible patients were initially subjected to esophageal manometry and ambulatory 3-h postprandial esophageal pH monitoring. All patients received H. pylori triple eradication therapy accompanied by successful H. pylori eradication. After successful eradication of H. pylori (confirmed by 13C urea breath test), a second manometry and 3-h postprandial esophageal pH monitoring were introduced to assess the results of eradication therapy, after a 3-month post-treatment period.

Results All 29 selected H. pylori-positive patients became negative due to successful H. pylori eradication, evaluated by 13C urea breath test after a 4-week post-treatment period. Post-eradication, 62.1% patients showed similar manometric pattern at baseline; 17.2% showed improvement; 17.2% normalization; and 3.4% deterioration of the manometric patterns. The DeMeester symptom scoring in the 3-h postprandial ambulatory esophageal pH monitoring was improved aft r eradication of H. pylori (median 47.47 vs. 22.00, Wilcoxon's singed rank; P=0.016). On comparing the pH monitoring studies for each patient at baseline and post-eradication period, 82.8% patients showed improvement and 17.2% deterioration of the DeMeester score.

Conclusion By using 3-h postprandial esophageal pH monitoring, this study showed, for the first time, that H. pylori eradication may positively infl ence GERD symptoms. Large-scale controlled relative studies are warranted to confi m these findings.

Keywords Helicobacter pylori, gastro-esophageal reflux disease, esophageal pH monitoring, DeMeester symptom scoring

Ann Gastroenterol 2014; 27 (4): 352-356

Original Articles