Gastroenterology

Gastroenterology

Volume 115, Issue 1, July 1998, Pages 50-57
Gastroenterology

Alimentary Tract
The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease,☆☆

https://doi.org/10.1016/S0016-5085(98)70364-6Get rights and content

Abstract

Background & Aims: The role of Helicobacter pylori in the pathogenesis of gastroesophageal reflux disease (GERD) is unknown. We determined the prevalence of cagA-positive (cagA+) H. pylori strains in patients with GERD or its complications compared with controls of similar age. Methods: A total of 153 consecutive patients with GERD, Barrett's esophagus, and Barrett's esophagus complicated by dysplasia or adenocarcinoma were compared with 57 controls who underwent upper endoscopy for reasons other than GERD. H. pylori infection and CagA antibody status were determined by histology and enzyme-linked immunosorbent assay. Results: H. pylori prevalence was lower (34%) in patients with GERD and its sequelae than in the control group (45.6%)(P = 0.15). Regardless of the group, increasing age was associated with higher prevalence of H. pylori (P = 0.003). When compared with controls (42.3%), the prevalence of cagA+H. pylori strains decreased (P = 0.008) in patients with more severe complications of GERD (GERD, 36.7% [nonerosive GERD, 41.2%; erosive GERD, 30.8%]; Barrett's esophagus, 13.3%; and Barrett's with adenocarcinoma/dysplasia, 0%). Conclusions: Prevalence of H. pylori in patients with GERD and its sequelae was lower but not significantly different than that of a control group. However, patients carrying cagA+ strains of H. pylori may be protected against the complications of GERD, especially Barrett's esophagus and its associated dysplasia and adenocarcinoma.

GASTROENTEROLOGY 1998;115:50-57

Section snippets

Patient population

Patients were enrolled at the Cleveland Clinic Foundation and the Nashville Department of Veterans Affairs Medical Center from September 1995 to January 1997. The study was approved by the Institutional Review Boards of both institutions. Informed consent was obtained in advance from all patients, and background data were collected on age, sex, race, diagnosis, reflux symptoms (including frequency and duration), and medications.

Before endoscopy, patients were questioned about frequency and

Prevalence of H. pylori

A total of 210 patients were evaluated, including 57 controls, 84 patients with GERD (48 nonerosive and 36 erosive), 48 patients with Barrett's esophagus (30 with conventional Barrett's esophagus and 18 with short-segment Barrett's esophagus), and 21 patients with Barrett's esophagus complicated by dysplasia or adenocarcinoma (12 patients with previous esophagectomy). The control population included patients with achalasia (18 patients), familial adenomatous polyposis (2 patients), chronic

Discussion

In this study, we showed that the prevalence of H. pylori infection in patients with GERD (erosive and nonerosive), Barrett's esophagus, and Barrett's esophagus complicated by dysplasia or adenocarcinoma is lower than in a control group of similar age, confirming the recent findings of Werdmuller and Loffeld.21 Although the magnitude of the difference was similar in the two studies, the results were statistically significant in the Werdmuller and Loffeld study,21 but not in this study, because

Acknowledgements

The authors thank Tom Lang for his helpful comments and suggestions in reviewing this manuscript.

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    Address requests for reprints to: Gary W. Falk, M.D., Department of Gastroenterology, Desk S-40, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195. e-mail: [email protected]; fax: (216)444-9416.

    ☆☆

    Supported by a research grant from Astra-Merck and from the Medical Research Service of the Department of Veterans Affairs.

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