Effect of helicobacter pylori eradication response to proton pump inhibitors in gastro-oesophageal reflux disease: Results from a randomized clinical trial
Introduction: Gastro-oesophageal Reflux Disease (GORD) is a common disorder associated with significant impairment in quality of life. The effect of Helicobacter pylori (H pylori) eradication on GORD symptoms is not clear. Our aim was to determine whether eradication of H pylori is associated with decreased symptom response to GORD treatment.
Methods: We recruited 45 consecutive patients presenting to our Tygerberg Hospital gastroenterology department with reflux symptoms and a GerdQ symptom score of 8 or more. Oesophagogastroduodenoscopy with gastric biopsies and a rapid urease test for H pylori was done. All patients were started on omeprazole 20 mg daily. After 4 weeks a second GerdQ questionnaire was administered and patients with H pylori were started on eradication therapy. After 6 weeks a third GerdQ questionnaire was administered. Four categories of outcome were created based on Antral and Corpus Helicobacter pylori result, whether positive or negative or both and associated risk factors were assessed using binary logistic regression. Results with p-values<0.05 were statistically significant
Results: Of the 45 patients evaluated, 73% (n=33) were H pylori positive and 27% (n=12) were negative. There were no statistically significant differences between the two groups (H. Pylori positive and H. Pylori negative) in gender distribution, smoking status, body mass index, waist-hip ratio or haemoglobin A1C levels. All except two patients were of mixed race. The H pylori negative group had a mean 1stGerdQ score of 12.41 compared to 11.45 (p-value 0.37) for the H pylori positive group. There were no statistical difference in the 2nd score (4.08 vs 4.47, p-value 0.316) or the 3rdGORDQ (3.67 vs 3.19, p-value 0.926) comparing the H pylori negative group and H pylori positive groups.
Conclusions: Our results demonstrated that eradication of H pylori had no influence on response to proton pump inhibitors among GORD patients. Clinicians should eradicate H pylori if it is found in GORD patients and may prevent future H pylori complications.