The occurrence of Helicobacter pylori infection and gastroesophageal reflux disease

Prevalence of Helicobacter pylori in patients with gastroesophageal reflux disease does not differ from a general population. The bacteria are present neither in normal epithelium nor in epithelium changed by inflammation because under normal conditions no gastric epithelium is found in esophagus. The increased prevalence of gastroesophageal reflux disease during recent years is associated with a decrease of Helicobacter pylori infection leading to speculations that Helicobacter pylori might be beneficial. The gastric inflammation caused by Helicobacter pylori infection decreases a gastric acid secretion that may explain why the intensity of reflux is not so intense and severe esophagitis does not occur. Results of epidemiologic studies differ, some of them show a protective effect against esophageal reflux disease and others show that the effect is not clinically relevant. The presence of Helicobacter pylori has no effect on percentage of relapses of the reflux esophagitis after a short-term treatment with omeprazol. Patients with duodenal and gastric ulcer undergoing an eradication therapy of Helicobacter pylori infection do not have a higher incidence of reflux esophagitis. Inflammatory changes in cardia („carditis“) are found in mucosa under the Z line in patients with reflux disease. These changes may be caused by Helicobacter pylori infection as well. Barrett’s esophagus with high degree dysplasia and adenocarcinoma of esophagus are significantly more frequent in patients who do not have Helicobacter pylori infection. Current opinions on eradication of Helicobacter pylori infection are not in esophageal reflux disease unanimous. Eradication is recommended in cases with concomitant peptic ulcer disease.

Keywords: Key words: Helicobacter pylori, esophageal reflux disease, esophagitis, carditis, Barrett’s esophagus, proton pump inhibitors.