Effect of Helicobacter pylori infection and its eradication on reflux esophagitis and reflux symptoms

Am J Gastroenterol. 2010 Oct;105(10):2153-62. doi: 10.1038/ajg.2010.251. Epub 2010 Jun 22.


Objectives: We evaluated the association between current Helicobacter pylori infection and reflux esophagitis and the effect of H. pylori eradication on reflux esophagitis in a healthy screening population.

Methods: A total of 10,102 subjects in a comprehensive screening cohort were enrolled, and 4,007 subjects had follow-up after a median of 2 years. Effects of H. pylori infection on reflux esophagitis were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis. We evaluated the change in prevalence of reflux esophagitis and reflux symptoms after H. pylori eradication vs. persistence.

Results: The prevalence of reflux esophagitis (as classified by the Los Angeles system) was 4.9% (490/10,102). Whereas the prevalence of reflux esophagitis was 6.4% (319/4,971) in subjects without H. pylori infection, it was 3.3% (171/5,131) in subjects with infection (P<0.001). H. pylori infection had a strong negative association with reflux esophagitis in multivariate analysis (OR 0.42; 95% CI, 0.34-0.51). Compared with the prevalence of reflux esophagitis in the persistent infection group, the prevalence of reflux esophagitis increased after successful H. pylori eradication (OR 2.34; 95% CI, 1.45-3.76; P<0.001), which was comparable to that of the H. pylori-negative group (OR 2.42; 95% CI, 1.73-3.36; P<0.001). However, reflux symptoms had no association with H. pylori infection or eradication.

Conclusions: In a healthy screening population, H. pylori infection had a strong negative association with reflux esophagitis, but H. pylori eradication increased the prevalence of erosive esophagitis to the level of H. pylori-negative individuals. Long-term clinical significance of newly developed erosive esophagitis after H. pylori eradication should be evaluated prospectively.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Ulcer Agents / therapeutic use
  • Chi-Square Distribution
  • Clarithromycin / therapeutic use
  • Cross-Sectional Studies
  • Esophagitis, Peptic / epidemiology*
  • Esophagitis, Peptic / microbiology*
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / epidemiology*
  • Humans
  • Logistic Models
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Omeprazole / therapeutic use
  • Patient Selection
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Clarithromycin
  • Omeprazole