The Pharmaceutical Journal
Vol 272 No 7299 p600
15 May 2004

This article
Reprint   Photocopy

PDF 35K, Acrobat Reader

Helicobacter pylori eradication may cause minor worsening of gastro-oesophageal disease

POEM series

Clinical question Does eradication of Helicobacter pylori worsen symptoms of gastro-oesophageal reflux?

Bottom Line The authors argue that eradication of H pylori worsens symptoms of gastro-oesophageal reflux disease (GORD). However, although their study found a small worsening in a handful of patients during the initial phase of treatment, they found no adverse effect during the maintenance phase. Unless additional, larger studies confirm this association, we should remain comfortable treating H pylori infection in dyspeptic patients as a way to treat possible or confirmed ulcers.

Synopsis It is controversial whether eradication of H pylori worsens, improves or has no effect on symptoms of GORD. In this study, H pylori-positive patients with GORD who had no ulcer on initial endoscopy were randomised (allocation concealed) to omeprazole 20mg per day plus H pylori eradication (n=53) or omeprazole 20mg per day plus placebo (n=51). Eradication was successful in 98 per cent of the eradication group, and 3.9 per cent of the placebo group were H pylori-negative at the end of the study. Analysis was by intention to treat and groups were similar at baseline. Patients were followed up for 12 months. The primary outcome was treatment failure, although this was defined using a combination of patient-oriented outcomes (failure of symptoms to resolve) and disease-oriented outcomes (persistent oesophagitis by endoscopy). What really matters, of course, are the patient-oriented outcomes, so we will only discuss those. Patients in the eradication group had four treatment failures during the initial phase of treatment and 10 during the maintenance phase. Patients in the placebo group had eight treatment failures during maintenance. The authors theorise that perhaps as the antral gastritis caused by H pylori infection resolves, acid secretion increases, causing worsening reflux.

Level of evidence 1b (individual RCT with narrow confidence interval).

Reference Wu JC, Chan FK, Ching JY, et al. Effect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: a double blind, placebo controlled, randomised trial. Gut 2004;53:174-79.

POEM (Patient Oriented Evidence that Matters) is a registered trademark of InfoPOEMs
© infoPOEMs 1995–2004