Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF

Correlation between Helicobacter pylori infection and reflux esophagitis: still an ongoing debate

The Egyptian Journal of Internal Medicine volume 29, pages 24–29 (2017)Cite this article

Abstract

Context

The vast majority of pathologies in the oesophagus, stomach and duodenum are related to either H. pylori infection or gastro-oesophageal reflux disease (GERD). Both conditions affect a large proportion of the population and they may occur either independently or concomitantly. The question of whether the two conditions are mutually exclusive, synergistic, or simply independent is an issue that was raised several years ago and is a matter of ongoing debate.

Aim

We aimed to determine the correlation between gastric Helicobacter colonization and grossly and histologically proven reflux esophagitis.

Settings and design

This work was designed as a descriptive cross-sectional study.

Patients and methods

The study was conducted on 50 patients, five women and 45 men, aged 19–79 years (mean: 35.3 years). The inclusion criterion was having a history of symptoms suggestive of GERD.

The cases were chosen from among outpatients and inpatients undergoing diagnostic endoscopic study at the endoscopy unit. The main presenting complaints were GERD symptoms, dyspepsia and postprandial epigastric pain. All cases were subjected to thorough history taking regarding the details and nature of the presenting complaint, special habits including caffeine consumption, smoking, and intake of medications such as antacids and H2 blockers, complete physical examination and upper endoscopy.

Detailed description of upper endoscopic examination was reported, including the grade of esophagitis according to Savary–Miller classification.

Three groups of biopsies were taken from each case: the first set from the lower end of the oesophagus and the two other sets from the gastric antrum. The oesophageal biopsies and one set of gastric biopsies were examined histologically after being processed.

The second gastric biopsy set was used for direct detection of H. pylori using the rapid urease test (Campylobacter-like organism test). The rapid urease test offers a sensitivity of 80–99% and a specificity of 92–100% in untreated patients when compared with histology as the gold standard in the diagnosis of H. pylori infection.

Statistical analysis

Data were statistically described in terms of frequencies (number of cases) and percentages and compared using the χ2-test. The exact test was used when the expected frequency was less than 5.

Results

On using the rapid urease enzyme test there were 44 (88%) positive cases and six (12%) negative cases for H. pylori.

By direct histopathologic examination there were 32 (64%) positive cases and 18 (36%) negative cases for H. pylori.

There was no statistically significant correlation between gastric colonization with H. pylori and reflux esophagitis diagnosed grossly and histopathologically.

Conclusion

The study showed no statistically significant correlation between H. pylori infection and the presence of reflux esophagitis.

References

  1. Hong SJ, Kim SW. Helicobacter pylori infection in gastroesophageal reflux disease in the Asian countries. Gastroenterol Res Pract 2015; 2015: 985249.

    Article  Google Scholar 

  2. Wang AY, Peura DA. The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world. Gastrointest Endosc Clin N Am 2011; 21:613–635.

    Article  Google Scholar 

  3. Raghunath A, Hungin AP, Wooff D, Childs S. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ 2003; 326:737.

    Article  Google Scholar 

  4. Savary M, Miller G. The Esophagus. Handbook and Atlas of Endoscopy, Solothurn, Switzerland: Verlag Grassmann; 1978. pp. 135–142.

  5. Lim LL, Ho KY, Ho B, Salto-Tellez M. Effect of biopsies on sensitivity and specificity of ultra-rapid urease test for detection of Helicobacter pylori infection: a prospective evaluation. World J Gastroenterol 2004; 10: 1907–1910.

    Article  Google Scholar 

  6. Tytgat GN. The Sydney System: endoscopic division. Endoscopic appearances in gastritis/duodenitis. J Gastroenterol Hepatol 1991; 6: 223–234.

    Article  CAS  Google Scholar 

  7. Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med 2015; 3:10.

    PubMed  PubMed Central  Google Scholar 

  8. Mahdi BM. The relationship between Helicobacter pylori infection and gastro-esophageal reflux disease. N Am J Med Sci 2011; 3:142–145.

    Article  Google Scholar 

  9. Maris T, Ilias A, Kapetanos D, Augerinos A, Xiarhos P, Gagalis A, et al. Helicobacter pylori eradication improves acid reflux and esophageal motility in patients with gastroesophageal reflux disease and antral gastritis. Ann Gastroenterol 2008; 21:233–236.

    Google Scholar 

  10. Garrido Serrano A, Lepe Jiménez JA, Guerrero Igea FJ, Perianes Hernández C. Helicobacter pylori and gastroesophageal reflux disease. Rev Esp Enferm Dig 2003; 95:788–790.

    CAS  PubMed  Google Scholar 

  11. Eren M, Çolak Ö, Işıksoy S, Yavuz A. Effect of H. pylori infection on gastrin, ghrelin, motilin, and gastroesophageal reflux. Turk J Gastroenterol 2015; 26:367–372.

    Article  Google Scholar 

  12. Xue Y, Zhou LY, Lin SR, Hou XH, Li ZS, Chen MH, et al. Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study. Chin Med J 2015; 128:995–999.

    Article  Google Scholar 

  13. Sugimoto M, Uotani T, Ichikawa H, Andoh A, Furuta T. Gastroesophageal reflux disease in time covering eradication for all patients infected with Helicobacter pylori in Japan. Digestion 2016; 93:24–31.

    Article  CAS  Google Scholar 

  14. Grande M, Lisi G, De Sanctis F, Grande S, Esser A, Campanelli M, et al. Does a relationship still exist between gastroesophageal reflux and Helicobacter pylori in patients with reflux symptoms? World J Surg Oncol 2014; 12:375.

  15. Manes G, Esposito P, Lioniello M, Bove A, Mosca S, Balzano A. Manometric and pH-metric features in gastro-oesophageal reflux disease patients with and without Helicobacter pylori infection. Dig Liver Dis 2000; 32:372–377.

    Article  CAS  Google Scholar 

  16. Kuipers EJ, Nelis GF, Klinkenberg-Knol EC, Snel P, Goldfain D, Kolkman JJ, et al. Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 2004; 53:12–20.

    Article  CAS  Google Scholar 

  17. Chung SJ, Lim SH, Choi J, Kim D, Kim YS, Park MJ, et al. Helicobacter pylori serology inversely correlated with the risk and severity of reflux esophagitis in Helicobacter pylori endemic area: a matched case-control study of 5,616 health check-up Koreans. J Neurogastroenterol Motil 2011; 17:267–273.

    Article  Google Scholar 

  18. Wu JCY, Chan FKL, Wong SKH, Lee YT, Leung WK, Sung JJY. Effect of Helicobacter pylori eradication on oesophageal acid exposure in patients with reflux oesophagitis. Aliment Pharmacol Ther 2002; 16:545–552.

    Article  CAS  Google Scholar 

  19. Awad R, Camacho S. Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux. J Gastroenterol 2002; 37:247–254.

    Article  CAS  Google Scholar 

  20. Iijima K, Koike T, Shimosegawa T. Reflux esophagitis triggered after Helicobacter pylori eradication: a noteworthy demerit of eradication therapy among the Japanese? Front Microbiol 2015; 6:566.

  21. Rubenstein JH, Inadomi JM, Scheiman J, Schoenfeld P, Appelman H, Zhang M, et al. Association between Helicobacter pylori and Barrett’s esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol 2014; 12: 239–245.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Cairo University, Cairo, Egypt

    Mohamed Saeed Hussein Gomaa (Associate Professor of Medicine)

  2. Pathology Department Faculty of Medicine, Cairo University, Cairo, Egypt

    Maha Mosaad Mosaad

Authors
  1. Mohamed Saeed Hussein Gomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maha Mosaad Mosaad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed Saeed Hussein Gomaa.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomaa, M.S.H., Mosaad, M.M. Correlation between Helicobacter pylori infection and reflux esophagitis: still an ongoing debate. Egypt J Intern Med 29, 24–29 (2017). https://doi.org/10.4103/ejim.ejim_9_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_9_17

Keywords