[Helicobacter pylori gastric infection is a protection factor for gastroesophageal reflux disease]

To know the relationship between endoscopic esophagitis and H. pylori infection.

The incidence of gastric cancer and peptic ulcer disease has declined in recent years, while GERD, Barrett esophagus, and distal esophageal adenocarcinoma have increased. Some authors think these epidemiologic changes are related to the simultaneous decrease in H. pylori colonization.

From 1997 to 1999, 192 patients underwent gastrointestinal endoscopy and detection of H. pylori (rapid urease test and/or seric antibodies and/or histologic examination and/or C13 marked urea). Patients were retrospectively divided according to endoscopic diagnosis of esophagitis (Savary-Miller) and positivity of any H. pylori test. Both groups were compared using Fisher exact test and odds ratio (OR) with 95% confidence intervals (CI 95%).

A total of 80 (40.6%) were H. pylori-positive without esophagitis, and 18 (9.4%) had esophagitis and H. pylori positivity (p = 0.01) [OR = 0.39 (CI 95% = 0.15-0.62)]. Of the remaining 133 patients, after separating those who received treatment that could modify GERD (n = 59), and 50 (37.6%), were H. pylori without positive without esophagitis) 18 (13.5%) had esophagitis and H. pylori positivity maintaining significance p = 0.003) [OR 0.32 (CI 95% (-0.1)-0.8)]. The severity of the esophagitis (Savary-Miller) was compared with the presence of Helicobacter pylori, but no relationship was found (p = 0.3).

1) Helicobacter pylori infection seems to be a protective factor for the presence of endoscopic esophagitis. 2) When esophagitis is present, the degree of damage appears to be independent of the H. pylori infection.