The Intriguing Relationship of Helicobacter Pylori Infection and Gastro-Oesophageal Reflux Disease

  • C. Knippig
  • P. Malfertheiner


The interesting pathophysiological interaction between Helicobacter pylori infection, type of gastritis, acid secretion and GORD complicated by weakness of study designs with small numbers of patients should not lead to confusion. The risk of gastric carcinogenesis and peptic ulcer formation against the need for possible higher doses of acid suppressive therapy for symptom control after eradication should be balanced carefully and can only lead us to one conclusion: there are more reasons that favour Helicobacter pylori eradication than to leave the bug in the stomach of your patients.


Atrophic Gastritis Oesophageal Adenocarcinoma GORD Symptom Oesophageal Acid Exposure cagA Strain 


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  1. [1]
    Kang JY (2004) Geographical and ethnic differences in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 20: 705–717PubMedCrossRefGoogle Scholar
  2. [2]
    Delaney BC (2004) Prevalence and epidemiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 20(Suppl 8): 2–4PubMedCrossRefGoogle Scholar
  3. [3]
    Koike T, Ohara S, Sekine H (2001) Helicobacter pylori infection prevents erosive reflux oesophagitis by decreasing gastric acid secretion. Gut 1: 330–334CrossRefGoogle Scholar
  4. [4]
    Loffeld FJLF, Werdmuller BFM, Kuster JA (2000) Colonization with cagA positive Helicobacter pylori prevastrains inversely associated with reflux esophagitis and Barrett’s esophagus. Digestion 62: 95–99PubMedCrossRefGoogle Scholar
  5. [5]
    Vicari JJ, Peek RM, Falk GW (1998) The seroprevalence of cagA positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease. Gastroenterology 115: 50–57PubMedCrossRefGoogle Scholar
  6. [6]
    Fallone CA, Barkun AW, Friedman G (2000) Is Helicobacter pylori eradication associated with gastroesophageal reflux disease? Am J Gastroenterol 95: 914–920PubMedCrossRefGoogle Scholar
  7. [7]
    Raghunath A, Pali A, Hungin S (2003) Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ 326: 737–739PubMedCrossRefGoogle Scholar
  8. [8]
    Wu JCY, Sung Jy, Ng EK (1999) Prevalence and distribution of Helicobacter pylori in gastroesophageal reflux disease: a study from the East. Am J Gastroenterol 94: 1790–1794PubMedCrossRefGoogle Scholar
  9. [9]
    O’Connor HJ (1999) Helicobacter pylori and gastro-oeosphagela reflux disease — clinical implications and management. Aliment Pharmacol Ther 13: 117–127PubMedCrossRefGoogle Scholar
  10. [10]
    Labenz J, Malfertheiner P (1997) Helicobacter pylori in gastro-oesophageal reflux disease: causal agent, independent or protective factor? Gut 41: 277–280PubMedCrossRefGoogle Scholar
  11. [11]
    Koike T, Ohara S, Sekine H (1999) Helicobacter pylori infection inhibits reflux oesophagitis by inducing atrophic gastritis. Am J Gastroenterology 94: 3468–3472CrossRefGoogle Scholar
  12. [12]
    Yamaji Y, Mitsushima T, Ikuma H (2001) Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oeosphagitis compared with gastric cancer: analysis of 5732 Japanese subjects. Gut 49: 335–340PubMedCrossRefGoogle Scholar
  13. [13]
    El Serag Hb, Sonnenberg Am, Jamal MM (1999) Corpus gastritis is protective against reflux oesophagitis. Gut 45: 181–185PubMedCrossRefGoogle Scholar
  14. [14]
    Hamada H, Haruma K, Mihara M (2000) High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori: impacts of hiatal hernia and corpus gastritis. Aliment Pharmacol Ther 14: 729–735PubMedCrossRefGoogle Scholar
  15. [15]
    Koike T, Ohara S, Sekine H (2001) Increased gastric acid secretion after Helicobacter pylori eradication may be a factor for developing reflux oeosphagitis. Aliment Pharmacol Ther 15: 813–820PubMedCrossRefGoogle Scholar
  16. [16]
    El-Omar EM, Oien K, El-Nujumi A (1997) Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology 113: 15–24PubMedCrossRefGoogle Scholar
  17. [17]
    Feldman M, Cryer B, Sammer D (1999) Influence of Helicobacter pylori infection on meal stimulated gastric acid secretion and gastroesophageal reflux. Am J Physiol 277: G1159–G1164PubMedGoogle Scholar
  18. [18]
    Wu JC, Chan FK, Wang SK (2002) Effect of Helicobacter pylori eradication on oesophageal acid exposure in patients with reflux esophagitis. Aliment Pharmacol Ther 16: 545–552PubMedCrossRefGoogle Scholar
  19. [19]
    Verdu EF, Armstrong D, Fraser R (1995) Effect of Helicobacter pylori status on intergastric pH during treatment with omeprazole. Gut 37: 743–748PubMedGoogle Scholar
  20. [20]
    Bercik P, Verdu EF, Armstrong D (2000) The effect of ammonia on omeprazole induced reduction of gastric acidity in subjects with Helicobacter pylori infection. Am J Gastroenterol 95: 947–955PubMedCrossRefGoogle Scholar
  21. [21]
    Gillen D, Wirz AA, Ardill JE (1999) Rebound hyper-secretion after omeprazole and its relation to on-treatment acid suppression and Helicobacter pylori status. Gastroenterology 116: 239–247PubMedCrossRefGoogle Scholar
  22. [22]
    Adamek RJ, Behrendt J, Wenzel C (2001) Relapse and prevention in reflux oeosphagitis with regard to Helicobacter pylori status: a double-blinded randomised, multicenter trial to compare the efficacy of pantoprazole versus ranitidine. Eur J Gastroenterol Hepatol 13: 811–817PubMedCrossRefGoogle Scholar
  23. [23]
    Labenz J, Blum AL, Bayerdorffer E (1997) Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis. Gastroenterology 112: 1442–1447PubMedCrossRefGoogle Scholar
  24. [24]
    Telfera S, Hatlebakk JG, Berstad A (1999) The effect of Helicobacter pylori eradication on gastro-oesophageal reflux. Aliment Pharmacol Ther 13: 915–920CrossRefGoogle Scholar
  25. [25]
    Moayyedi P, Bardhan C, Young L (2001) Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease. Gastroenterology 121: 1120–1126PubMedCrossRefGoogle Scholar
  26. [26]
    Manifold DK, Anggiansah A, Rowe I (2001) Gastrooesophageal reflux and duodenogastric reflux before and after eradication in Helicobacter pylori gastritis. Eur J Gastroenterol Hepatol 13: 535–539PubMedCrossRefGoogle Scholar
  27. [27]
    Kuipers EJ, Nelis GF, Klinkenberg-Knol EC, Snel P, Goldfain D, Kolkman JJ, Festen HPM, Dent J, Zeitoun P, Havu N, Lamm M, Walan A (2004) Cure of Helicobacter pylori infection in pateintes with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 53: 12–20PubMedCrossRefGoogle Scholar
  28. [28]
    Schwizer W, Thurmshirn M, Dent J (2001) Helicobacter pylori and symptomatic relapse of gastro-esophageal reflux disease: a randomized controlled trial. Lancet 357: 1738–1742PubMedCrossRefGoogle Scholar
  29. [29]
    El Omar E, Perman I, Dorrian CA (1993) Helicobacter pylori infection lowers gastrin mediated acid secretion by two thirds in duodenal ulcer patients. Gut 34: 1060–1065PubMedGoogle Scholar
  30. [30]
    Kupcinskas L, Jonaitis L, Kudelis G (2004) A 1 year follow-up study of the consequences of Helicobacter pylori eradication in duodenal ulcer patients: unchanged frequency of erosive oesophagitis and decreased preva lence of non-erosive gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 16: 369–374PubMedCrossRefGoogle Scholar
  31. [31]
    Rokkas T, Ladas S, Triantafyllou K (2001) The association between CagA status and the development of esophagitis after the eradication of Helicobacter pylori. Am J Med 110: 703–707PubMedCrossRefGoogle Scholar
  32. [32]
    Warburton-Timms VJ, Charlett A, Valori RM (2001) The significance of cagA+ Helicobacter pylori in reflux oesophagitis. Gut 49: 341–346PubMedCrossRefGoogle Scholar
  33. [33]
    Jakobs R, Riemann JF (2004) CagA-positive Helicobacter pylori strains and gastrooesophageal erflux disease: still puzzling. European Jounal of Gastroenterol Hepatol 16: 635–637CrossRefGoogle Scholar
  34. [34]
    Wu JCY, Chan FKL, Ching JYL, Leung W-K, Hui Y, Leong R, Chung SCS, Sung JJY (2004) Effect of Helicobacter pylori eradication on treatment of gastrooesophageal reflux disease: a double blind, placebo controlled, randomised trial. Gut 53: 174–179PubMedCrossRefGoogle Scholar
  35. [35]
    Labenz J, Tillenburg B, Peitz U (1996) Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer. Gastroenterology 110: 725–732PubMedCrossRefGoogle Scholar
  36. [36]
    Martinek J, Kuzela I, Spicak J (2000) Review article: the clinical influence of Helicobacter pylori in effective acid suppression — implications for the treatment of gastroesophageal reflux disease. Aliment Pharmacol Ther 14: 979–990PubMedCrossRefGoogle Scholar
  37. [37]
    Holtmann G, Cain C, Malfertheiner P (1999) Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazoel. Gastroenterology 117: 11–16PubMedCrossRefGoogle Scholar
  38. [38]
    Hatlebakk JG, Hyggen A, Madsen PH (1999) Heartburn treatment in primary care: randomised double-blind study for 8 weeks. BMJ 319: 550–554PubMedGoogle Scholar
  39. [39]
    Malfertheiner P, Stolte M, Willich SN (submitted 2004) Prognostic influence of Barrett’s epithelium and of Helicobacter pylori infection on healing of erosive and non-erosive gastro-esophageal reflux disease — Report from the PROGORD StudyGoogle Scholar
  40. [40]
    Schenk BE, Kuipers EJ, Klinkenberg-Knol EC (1999) Helicobacter pylori and the efficacy of omeprazole therapy for gastroesophageal reflux disease. Am J Gastroenterol 94: 884–887PubMedCrossRefGoogle Scholar
  41. [41]
    Carlsson R, Bate C, Dent J (1997) Does Helicobacter pylori infection influence the response to treatment with acid inhibition in patiens with GORD? Scand J Gastroenterol 32(Suppl 224): F70Google Scholar
  42. [42]
    Peter FTM, Kuipers EJ, Ganesh S (1999) The influence of Helicobacter pylori on oesophageal acid exposure in GORD during acid supressive therapy. Aliment Pharmacol Ther 13: 921–926CrossRefGoogle Scholar
  43. [43]
    Vakikl N, Kahrilas P, Magner D (2000) Does baseline Helicobacter pylori status impact erosive esophagitis healing rates? Am J Gastroenterol 95: 2438ACrossRefGoogle Scholar
  44. [44]
    Kuipers EJ, Lundell L, Klinkenberg-Knol EC (1996) Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 334: 1018–1022PubMedCrossRefGoogle Scholar
  45. [45]
    McColl (2004) Helicobacter pylori infection and long term proton pump inhibitor therapy, Gut 53: 5–7PubMedCrossRefGoogle Scholar
  46. [46]
    Lundell L, Miettinen P, Myrvold HE (1999) Lack of effect of acid suppression therapy on gastric atrophy. Nodic GORD Study Group. Gastroenterology 117: 319–326PubMedCrossRefGoogle Scholar
  47. [47]
    Uemura N, Okamoto S, Ymamoto S (2000) Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during long-term acid — suppressive treatment in Japan. Aliment Pharmacol Ther 14: 1345–1352PubMedCrossRefGoogle Scholar
  48. [48]
    Geboes K, Dekker W, Mulder Cjj (2001) Longterm lansoprazole treatment for gastroesophageal reflux disease: clinical efficacy and influence on gastric mucosa. Aliment Pharmacol Ther 18: 1819–1826CrossRefGoogle Scholar
  49. [49]
    Stolte M, Meining A, Schmitz JM (1998) Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during 12 months of treatment with omeprazole and lansoprazole in patients with gastroesophageal reflux disease. Aliment Pharmacol Ther 12: 247–253PubMedCrossRefGoogle Scholar
  50. [50]
    Singh P, Indaram A, Greenberg R (2000) Long term omeprazole therapy for reflux esophagitis: follow-up in serum gastin levels, EC cell hyperplasia and neoplasia. World J Gastroenterol 6: 789–792PubMedGoogle Scholar
  51. [51]
    Kuipers EJ, Nelis GF, Klinkenberg-Knol EC (2001) Helicobacter eradication for the prevention of atrophic gastritis during omeprazole therapy; a prospective randomised trial. Gastroenterology 120(Suppl 1): A14Google Scholar
  52. [52]
    Uemura N, Okamoto S, Yamamoto S (2001) Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 345: 784–789PubMedCrossRefGoogle Scholar
  53. [53]
    Malfertheiner P, Megraud F, O’Morain C (2002) Current concepts in the management of Helicobacter pylori infection — the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 16: 167–180PubMedCrossRefGoogle Scholar
  54. [54]
    Weston AP, Sharma P, Mathur S, Banerjee S, Jafri K, Cherian R, McGregor D, Hassanein RS, Hall M (2004) Risk stratification of Barrett’s esophagus: updated prospective multivariate analysis. Am J Gastroenterol 99: 1657PubMedCrossRefGoogle Scholar
  55. [55]
    Abe Y, Ohara S, Koike T, Sekine H, Lijima K, Kawamura M, Imatani A, Kato K, Shimosegawa T (2004) The prevalence of Helicobacter pylori infection and the status of gastric acid secretion in patients with Barrett’s esophagus in Japan. Am J Gastroenterol 99: 1222–1225CrossRefGoogle Scholar
  56. [56]
    Clark GWB (2003) Effect of Helicobacter pylori infection in barrett’s esophagus and the genesis of esophageal adenocarcinoma. World J SurgeryGoogle Scholar
  57. [57]
    Pearsonnet J, Friedman GD, Orentrich N, Vogelman H (1997) Risk for gastric cancer in people with cagApositive or cagA-negative Helicobacter pylori infection. Gut 40: 297–301Google Scholar
  58. [58]
    Chow WA, Blaser MJ, Blot WJ, Gammon MD, Vaughan TL, Risch HA (1998) An inverse relation between cagA+ strains of Helicobcter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res 58: 588–590PubMedGoogle Scholar
  59. [59]
    Ackermark P, Kuipers EJ, Wolf C, Breuemlhof R, Seldenrijk CA, Timmer R, Segeren KC, Kusters JG, Smout AJ (2003) Colonization with cagA-positive Helicobacter pylori strains in intestinal metaplasia of the esophagus and the esophagogastric junction. Am J Gastroenterol 98: 1719–1724PubMedCrossRefGoogle Scholar
  60. [60]
    Forman D (2004) Review article: oesophago-gastric adenocarcinoma — an epidemiological perspective. Aliment Pharmacol Ther 20(Suppl 5): 55–60PubMedCrossRefGoogle Scholar
  61. [61]
    Quddus MR, Henley JD, Sulaiman RA (1997) Helicobacter pylori infection and adenocarcinoma arising in Barrett’s esophagus. Hum Pathol 28: 1007–1009PubMedCrossRefGoogle Scholar
  62. [62]
    Wright TA, Myskow M, Kingsnorth AN (1997) Helicobacter pylori colonization of Barrett’s esophagus and its progression to cancer. Dis Esophagus 10: 196–200PubMedGoogle Scholar
  63. [63]
    Jones AD, Bacon KD, Jobe BA, Sheppard BC, Deveney CW, Rutten JM (2003) Helicobacter pylori induces apoptosis in Barrett’s derived esophageal adenocarcinoma cells. J Gastrointest Surg 7: 68–76PubMedCrossRefGoogle Scholar
  64. [64]
    Deves SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83(10): 2049–2053CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2006

Authors and Affiliations

  • C. Knippig
    • 1
  • P. Malfertheiner
    • 1
  1. 1.Department of Gastroenterology, Hepatology and InfectiologyOtto-von-Guericke-Universität MagdeburgMagdeburgGermany

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