iBodyWise.com

Acid Reflux and H pylori

The test and treat approach of eradicating Helicobacter pylori infections in all patients with gastro-esophageal reflux disease was at the heart of a number of presentations at the annual Digestive Disease Week.

According to Dr. Robert Stuart of the Glasgow (Scotland) Royal Infirmary, the new data are decidedly in favor of eradication. "Out of the 12 studies on this subject presented this year [at the meeting], 9 suggest that eradication of H. pylori does not cause gastroesophageal reflux disease (GERD) or dyspepsia to get worse but, instead, may be beneficial."

Dr. Stuart conducted one of these studies on an H. pylori test and treat strategy. The patients were on maintenance therapy and had either uninvestigated heartburn (204 patients), or they had endoscopy-positive esophagitis (267 patients). Maintenance therapy was defined as at least three or more prescriptions a year for proton pump inhibitors or therapy with [H.sub.2]-receptor antagonists.
Patients were evaluated before starting therapy for H. pylori eradication and 6 months later using a standardized symptom scale, the Glasgow Dyspepsia Severity Score. A significant change was defined as a difference of three or more points. Of those whose H. pylori was successfully eradicated, 32% experienced a significant change in their scores. Of those whose infections were not eradicated, 22% had a significant change in scores. Also, 35% of the heartburn patients whose H. pylori was eradicated and 15% of those who were still infected were off drug therapy 1 year later.
H. pylori eradication also was associated with higher rates of symptom improvement and drug therapy discontinuation 1 year later. Patients with esophagitis and eradicated H. pylori did not benefit as much as did those with heartburn. However, H. pylori eradication did not adversely affect the patients and reduced prescribing costs 1 year later, he said.
Dr. Stuart's test and treatment assessment was part of a larger randomized, controlled trial of H. pylori eradication in dyspepsia patients who also were on maintenance therapy. That study also indicated that H. pylori eradication, irrespective of the patient's underlying diagnosis, significantly improved symptom and quality of life scores and reduced prescribing in a large dyspeptic population on maintenance acid suppression.
Patients in that study were randomized to active treatment and control groups. Patients given active treatment were analyzed by diagnosis--29% had endoscopy-confirmed ulcers, 44% had endoscopy-confirmed nonulcer disease, and 27% had not undergone endoscopy [[blank].sup.13]C-urea breath tests were positive in 52% of 937 patients; infection was successfully eradicated in 80%. Another study presented at the meeting came to the conclusion that "gastric infection with H. pylori seems to protect against the development of GERD symptoms."
Dr. Hector Cardona of the National University of Columbia, Bogota, qualified, however, that this finding did not extend to those with severe erosive complications of GERD, induding Barrett's esophagus. In the study, 348 GERD patients were tested for H. pylori infection, underwent an upper GI endoscopy, and completed a questionnaire about the frequency and duration of their GERD symptoms. H. pylori- negative patients had more GERD symptoms than H. pylori-positive ones.
Dr. Cardona did not differentiate the strains of H. pylori among the study participants. Audience members suggested that a low proportion of CagA infections, which are associated with more severe symptoms, may have accounted for the disparity.

COPYRIGHT 2001 International Medical News Group