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H. pylori eradication may worsen symptoms of GERD. (Rebound Acid Secretion May Result).

SAN FRANCISCO -- Helicobacter pylori eradication might be causing or worsening gastroesophageal reflux disease in some patients.

While not definitive, findings from studies presented at the annual Digestive Disease Week indicated that chronic H. pylori infection leads to gastric atrophy with reduced acid secretion and that H. pylori eradication may cause rebound acid secretion that can produce reflux disease.

In a study of healthy blood donors, 147 were found to have H. pylori infections and no endoscopic evidence of esophagitis. They were recruited for follow-up, and 73 were randomized to undergo H. pylori eradication. All study subjects had repeat evaluation and endoscopy 8 years later.

At the follow-up, endoscopic esophagitis was detected in. 14 of the 74 subjects who had not undergone H. pylori eradication and 21 of the 73 subjects who had been treated. The trend indicating that H. pylori might protect against esophagitis in asymptomatic people did not reach statistical significance.

"We are unable to show a difference, and that's all we can conclude," said Dr. Nimish Vakil of Sinai-Samaritan Medical Center, Milwaukee, one of the study investigators.

In another study H. pylori eradication was associated with poorer control of gastroesophageal reflux disease (GERD) in patients given maintenance therapy with a proton-pump inhibitor, said Dr. Justin Wu of Prince of Wales Hospital, Hong Kong.

Dr. Wu's study randomized 93 H. pylori-infected patients with mild to moderate reflux symptoms to either eradication therapy or to placebo. Omeprazole was given at a standard dose of 20 mg daily for 8 weeks and was then stepped down to 10 mg daily for patients who responded.

At 26 weeks, 41% of the H. pylori-negative patients and 18% of the placebo-treated H. pylori-positive patients had failed to respond to proton-pump inhibitor treatment. At 52 weeks, 49% and 23%, respectively had experienced reflux therapy failure.

A metaanalysis examined data from eight trials in which 1,165 patients with duodenal ulcers were treated with esomeprazole or omeprazole and H. pylori eradication. All underwent endoscopy, or data were available on their GERD symptoms. No association was seen between H. pylori eradication and the development of new erosive esophagitis, which was seen in 4% of patients who were cleared of H. pylori infection and in 3% of those with persistent H. pylori infection, said Dr. Loren Laine, a professor of medicine at the University of California, Los Angeles.

A 10,000-person, community-based study from Bristol, England, identified 1,634 individuals with H. pylori infection, of whom 1,558 were randomized to either treatment or placebo.

Treating H. pylori infection resulted in 3% less heartburn and 3% less reflux over 2 years in that trial. However, there was a subgroup of individuals for whom eradication seemed to exacerbate reflux--those who were obese, men, and those with initially troublesome GERD symptoms.

And in a study of 17 healthy, H. pylori--positive patients, treated individuals experienced rebound acid hypersecretion when omeprazole was halted after 8 weeks of treatment. Those not treated for their H. pylori infections did not have rebound hypersecretion.
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Title Annotation:gastroesophageal reflux disease
Author:Kirn, Timothy F.
Publication:Internal Medicine News
Article Type:Brief Article
Date:Aug 1, 2002
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