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Stefan Öberg, MD; Jeffrey H. Peters, MD; John J. Nigro, MD; Jörg Theisen, MD; Jeffrey A. Hagen, MD; Steven R. DeMeester, MD; Cedric G. Bremner, MD; Tom R. DeMeester, MD

Arch Surg. 1999;134:722-726.

Hypothesis  Helicobacter pylori is not associated with gastroesophageal reflux disease and its complications, including adenocarcinoma of the esophagus and the gastroesophageal junction (GEJ).

Design  Retrospective analysis.

Setting  University tertiary referral center.

Patients  Two hundred twenty-nine patients with symptoms suggestive of foregut disease underwent esophageal manometry, 24-hour pH monitoring, and upper gastrointestinal tract endoscopy, with biopsy specimens obtained from the gastric antrum, the GEJ, and the distal esophagus. In these and in an additional 114 patients with adenocarcinoma of the esophagus and the GEJ, the presence of H pylori was determined by Giemsa stain. The presence of gastroesophageal reflux disease, defined by abnormal esophageal acid exposure, and its manifestations (carditis, erosive esophagitis, intestinal metaplasia limited to the GEJ, Barrett esophagus, and adenocarcinoma of the esophagus and GEJ) were correlated with the presence of H pylori.

Results  Helicobacter pylori was found on the biopsy specimens of the gastric antrum in 14.0% (32/229) of the patients with benign disease. It was not related to the features of gastroesophageal reflux disease, including abnormal esophageal acid exposure, erosive esophagitis, or Barrett esophagus. The presence of inflamed cardiac mucosa at the GEJ or carditis was inversely related to H pylori infection and strongly associated with increased esophageal acid exposure. There was no association between the presence of intestinal metaplasia and H pylori infection. Helicobacter pylori was found in 22 (19.3%) of the 114 patients with esophageal adenocarcinoma, which was not different from the prevalence of H pylori in patients with benign disease.

Conclusion  Helicobacter pylori plays no role in the pathogenesis of gastroesophageal reflux disease or its complications.

From the Departments of Surgery, Lund University Hospital, Lund, Sweden (Dr Öberg); and University of Southern California, Los Angeles (Drs Peters, Nigro, Theisen, Hagen, S. R. DeMeester, Bremner, and T. R. DeMeester).

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