BMJ  2004;328:1417 (12 June), doi:10.1136/bmj.38082.626725.EE (published 4 May 2004)

Primary care

Randomised controlled trial of effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project

Richard F Harvey, consultant gastroenterologist1, J Athene Lane, research fellow2, Liam J Murray, senior lecturer3, Ian M Harvey, professor of epidemiology and public health4, Jenny L Donovan, professor2, Prakash Nair, consultant gastroenterologist5

1 Frenchay Hospital, North Bristol NHS Trust, Bristol BS16 1LE, 2 Department of Social Medicine, University of Bristol, Bristol BS8 2PR, 3 Department of Epidemiology and Public Health, The Queen's University of Belfast, Belfast BT9 5EE, 4 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, 5 Peterborough General Hospital, Peterborough

Correspondence to: R F Harvey richard.harvey1{at}virgin.net

Objectives To investigate the effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux.

Design Cross sectional study, followed by a randomised placebo controlled trial.

Setting Seven general practices in Bristol, England.

Participants 10 537 people, aged 20-59 years, with and without H pylori infection (determined by the 13C-urea breath test).

Main outcome measures Prevalence of heartburn and gastro-oesophageal acid reflux at baseline and two years after treatment to eradicate H pylori infection.

Results At baseline, H pylori infection was associated with increased prevalence of heartburn (odds ratio 1.14, 95% confidence interval 1.05 to 1.23) but not reflux (1.05, 0.97 to 1.14). In participants with H pylori infection, active treatment had no effect on the overall prevalence of heartburn (0.99, 0.88 to 1.12) or reflux (1.04, 0.91 to 1.19) and did not improve pre-existing symptoms of heartburn or reflux.

Conclusions H pylori infection is associated with a slightly increased prevalence of heartburn but not reflux. Treatment to eradicate H pylori has no net benefit in patients with heartburn or gastro-oesophageal reflux.


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