[Does H. pylori infection or its eradication play a role in gastroeosphageal reflux disease?]

The relationships between Helicobacter pylori (H. pylori)and gastroesophageal reflux disease (GERD) remain controversial. Epidemiological studies do not support an important role of H. pylori in the pathogenesis of GERD although some studies showing a low prevalence of the infection in GERD patients suggest that it could protect against the development of either symptoms or esophagitis. This hypothesis has been reinforced by the increased prevalence of esophagitis following H. pylori eradication in duodenal ulcer patients, although conflicting results have been reported. An increased gastric acid secretion following H. pylori eradication in patients who previously had corpus gastritis may explain this phenomenon. H. pylori eradication does not exacerbate GERD symptoms and may, in some cases, improve them. H. pylori-associated gastritis enhances the efficacy of antisecretory drugs as evidenced by the lower gastric pH values after eradication; however, as far as healing rates and symptom relief are concerned, the differences are probably not clinically relevant. Long term treatment with proton pump inhibitors could accelerate the development of atrophic gastritis, and therefore increase the risk of gastric cancer. However, conflicting results have been reported, so that further studies are needed before considering eradication of H. pylori systematically before long-term medical treatment for GERD.