Increased gastric acid secretion after Helicobacter pylori eradication may be a factor for developing reflux oesophagitis

Improvement of reflux symptoms 3 years after cure of Helicobacter pylori infection: a case-controlled study in the Japanese population

BACKGROUND

Development of reflux esophagitis is one of the adverse effects that cause concern in relation to curative treatment of Helicobacter pylori infection. However, recent studies present a rather negative association between curative treatment and development of reflux esophagitis or reflux symptoms. Therefore, this issue has remained controversial. Accordingly, we investigated the long-term adverse effects of H. pylori eradication treatment in special reference to development of reflux symptoms.

PATIENTS AND METHODS

We conducted a case controlled study by mailing structured questionnaires on past (before curative treatment or 3 years previously) and current status. A case was an endoscopically confirmed peptic ulcer patient with confirmed cure of the infection after eradication treatment 3 years previously and a control was one who had not undergone the eradication treatment during the same period. We studied 241 pairs who matched for age, gender, and type of ulcer disease (GU, DU or GDU). Of these pairs, 81.3% were male and the mean age was 52.6 +/- 9.6 year (range 23-76).

RESULTS

The rates of patients with improved reflux symptoms in the case and control groups were 65.4% and 30.4%, respectively, with the rate being significantly greater in the case group. On the contrary, the rates of those with worsened reflux symptoms were similar (5.1% and 7.6%). Regarding general events, the rate of patients with decreased frequency of hospital visits and of those who regularly used antiacid medications were significantly decreased in the case group. Furthermore, the case group experienced significantly fewer hospital admissions for various diseases in this 3-year period. However, a significantly greater number of case group patients than control subjects gained weight.

CONCLUSION

Reflux symptoms as well as general well-being were significantly improved after cure of H. pylori infection.

Review article: after gastritis--an imaginary journey into a Helicobacter-free world

This article explores the consequences of the world-wide trend that may result--at different times for different populations--in the disappearance of Helicobacter pylori and gastritis. After a brief historical introduction, some of the factors that contribute to the decrease in the prevalence of H. pylori are presented. The most apparent results of this trend in the industrialized world have been a decrease in the incidence of peptic ulcer and distal gastric adenocarcinoma. However, some other conditions of the upper digestive tract, such as acid reflux disease and adenocarcinoma of the cardio-oesophageal junction have been increasing. This simultaneous increase has led to the speculation that it may be causally related to the decreased prevalence of gastritis, and currents of thought supporting a laissez faire attitude with regards to H. pylori infection have developed. If these trends continue, future research aimed at understanding the pathogenesis of H. pylori-related conditions, including gastric carcinogenesis, will hinge on access to populations in which H. pylori is still highly prevalent, and on further refinement of the recently introduced Mongolian gerbil model.

Effect of Helicobacter pylori infection and its eradication on nutrition

AIMS

To investigate the effects of Helicobacter pylori infection and eradication on nutrition.

METHODS

The body weight, height, blood pressure, gastric juice pH and fasting serum levels of glucose, total protein, albumin, total cholesterol and triglyceride were measured in H. pylori-positive and H. pylori-negative subjects, and the effect of eradication of H. pylori on these parameters was determined. The development of gastro-oesophageal reflux disease after treatment was also examined. Eight patients underwent a pancreatic function test before and after H. pylori eradication therapy.

RESULTS

The incidence of hypoproteinaemia in H. pylori-positive subjects was significantly higher than that in H. pylori-negative subjects. After eradication of H. pylori, the gastric juice pH values were significantly decreased, and the body weight and serum levels of total cholesterol, total protein and albumin were significantly increased. The incidence of hyperlipidaemia significantly increased and that of hypoproteinaemia significantly decreased in the group with eradication. Pancreatic function improved significantly after eradication of H. pylori. No significant changes in these parameters were observed in the group without eradication. Obese patients had a higher risk of the development of gastro-oesophageal reflux disease after eradication of H. pylori infection.

CONCLUSIONS

The eradication of H. pylori appears to improve some nutritional parameters.