Impact of Helicobacter pylori infection on progression of nondysplastic Barrett's esophagus.

BACKGROUND

Helicobacter pylori infection is associated with a reduced risk of developing Barrett's esophagus. However, its impact on the progression of established nondysplastic Barrett's esophagus (NDBE) to dysplasia and esophageal adenocarcinoma (EAC) remains uncertain.

METHODS

We queried a large USs clinical database to identify adults with NDBE between 2015 and 2023. The primary exposure was H pylori infection; controls were uninfected patients with NDBE. A 1:1 propensity score matching was performed. The primary outcome was progression to dysplasia or EAC, defined as a new diagnosis during follow-up. Among patients infected with H pylori, subgroup analyses examined the association between eradication therapy, esophagitis, sex, age, and smoking and progression.

RESULTS

We identified 266,856 adults with NDBE, of whom 6262 had H pylori infection. After matching, progression to dysplasia or EAC was significantly higher in controls than in the H pylori cohort (8.3% vs 3.9%; P <.001; odds ratio [OR], 2.23; 95% CI, 1.91-2.61), with a similar result for progression to high-grade dysplasia and EAC alone. Among H pylori-infected patients, those who underwent eradication therapy had a higher progression to dysplasia or EAC compared with untreated individuals (6.0% vs 3.5%; P <.001; OR, 1.75; 95% CI, 1.35-2.26). The prevalence of esophagitis was similar between treated and untreated patients with H pylori.

CONCLUSION

H pylori infection was associated with a substantially lower risk of progression from NDBE to dysplasia or EAC. This association was attenuated after eradication therapy, but esophagitis was similar between the cohorts, suggesting that reflux severity did not explain the association. These findings support H pylori as a potential risk-stratification marker in NDBE.