Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma

Am J Gastroenterol. 2000 Feb;95(2):387-94. doi: 10.1111/j.1572-0241.2000.01758.x.


Objective: This study was undertaken to prospectively determine the prevalence of gastric H. pylori infection in Barrett's esophagus and Barrett's complicated by dysplasia or adenocarcinoma.

Methods: The prevalence of H. pylori was determined in Barrett's esophagus patients compared to a control population of patients with gastroesophageal reflux disease (GERD) only. All patients had a minimum of 10 gastric surveillance biopsies obtained. H. pylori colonization was determined upon the basis of hematoxylin and eosin and use of a modified Giemsa and or Steiner's silver stain of all gastric biopsy specimens.

Results: Two hundred and eighty-nine Barrett's patients and 217 GERD control patients were included in the study. H. pylori was found in 95/289 (32.9%) of the Barrett's patients, compared with 96/217 (44.2%) of the GERD controls (NS). Forty-seven of the Barrett's patients had low-grade dysplasia/indefinite dysplasia, 14 high-grade dysplasia, and 20 Barrett's adenocarcinoma. When Barrett's was subgrouped according to absence of dysplasia, and presence of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma, H. pylori prevalence was found to be significantly less for patients with Barrett's high-grade dysplasia (14.3%) and adenocarcinoma (15.0%) versus patients with GERD alone (44.2%), Barrett's alone (35.1%), or Barrett's with low-grade dysplasia (36.2%) (p = 0.016). This difference could not be explained by differences between Barrett's esophagus patients infected with H. pylori and those who were not with respect to gender, smoking history, alcohol consumption, use of proton pump inhibitor, or length of Barrett's mucosa.

Conclusions: Barrett's high-grade dysplasia and adenocarcinoma are significantly more prevalent in patients who are not infected with H. pylori. H. pylori appears to have a protective effect against the development of Barrett's adenocarcinoma.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / microbiology*
  • Alcohol Drinking / epidemiology
  • Analysis of Variance
  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / microbiology*
  • Barrett Esophagus / pathology
  • Biopsy
  • Chi-Square Distribution
  • Coloring Agents
  • Enzyme Inhibitors / therapeutic use
  • Esophageal Neoplasms / epidemiology
  • Esophageal Neoplasms / microbiology*
  • Esophagoscopy
  • Female
  • Follow-Up Studies
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / microbiology*
  • Helicobacter Infections / epidemiology*
  • Helicobacter pylori* / growth & development
  • Humans
  • Kansas / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Proton Pump Inhibitors
  • Smoking / epidemiology
  • Stomach Diseases / epidemiology
  • Stomach Diseases / microbiology*


  • Coloring Agents
  • Enzyme Inhibitors
  • Proton Pump Inhibitors