Helicobacter pylori and gastroesophageal reflux disease: the bug may not be all bad

Am J Gastroenterol. 1998 Oct;93(10):1800-2. doi: 10.1111/j.1572-0241.1998.00523.x.


Peptic ulcer disease and gastric cancer of the antrum and body have been declining in the 20th century. In contrast, a new group of diseases are increasingly rapidly in Western countries: gastroesophageal reflux disease, Barrett's esophagus, and adenocarcinoma of the distal esophagus. Recent studies suggest this phenomenon may be related to the simultaneous fall in the prevalence of Helicobacter pylori (H. pylori) colonization, especially by the virulent cagA + strains. H. pylori infection with the cagA+ strain is potentially protective against the spectrum of gastroesophageal reflux disease because it lowers intragastric acidity as the result of a pangastritis, frequently with multifocal gastric atrophy and possibly increased intragastric ammonia production. Assuming that some types of H. pylori strains are protective, our entire approach to the worldwide elimination of this organism, sometimes indiscriminately, will need critical reevaluation.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / prevention & control
  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / prevention & control
  • Esophageal Neoplasms / epidemiology
  • Esophageal Neoplasms / prevention & control
  • Esophagitis, Peptic / epidemiology
  • Esophagitis, Peptic / prevention & control
  • Gastric Acid / metabolism
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / prevention & control*
  • Helicobacter Infections* / epidemiology
  • Helicobacter Infections* / physiopathology
  • Helicobacter pylori*
  • Humans
  • Peptic Ulcer / microbiology*
  • Prevalence