Helicobacter pylori and reflux disease.

Currently, the influence of Helicobacter pylori infection on gastro-oesophageal reflux disease is a major focus of attention because it is an issue that is relevant to so many patients. There is accumulating evidence that it is the severity of H. pylori-induced gastritis that determines whether clinically relevant effects occur within individual patients. Several lines of evidence suggest that there is a protective effect against reflux disease if gastritis is severe enough to cause elevation of gastric pH above 3 for significant parts of the 24 h cycle. Conversely, H. pylori eradication would be expected to increase the risk of reflux disease if previously substantially reduced acid secretion recovers significantly as a result of healing of corpus gastritis. This analysis indicates that the interaction of H. pylori and reflux disease should differ for duodenal ulcer patients, who do not have major reductions of acid secretion, and for gastric ulcer or atrophic gastritis patients, who do. Available data that have assessed the effects of H. pylori eradication are especially difficult to interpret in patients with chronic peptic ulcer, because of several important confounding factors. In the case of duodenal ulcer, the available studies are very conflicting, and few have been published in full. For the most relevant patient group, those whose primary problem is reflux disease, there are currently no data available on the effects of H. pylori eradication.