Reflux and Helicobacter pylori

Helicobacter pylori is not a risk factor for gastro-oesophageal reflux and oesophagitis, and there are arguments suggesting that H. pylori may actually protect against gastro-oesophageal reflux disease. Gastro-oesophageal reflux disease patients are less often infected with H. pylori than controls. If infected, they may have less severe gastro-oesophageal reflux disease, and H. pylori infected duodenal ulcer patients without gastro-oesophageal reflux disease are potentially at risk of developing gastro-oesophageal reflux disease after eradication of the organism. In addition, H. pylori also affects the management of gastro-oesophageal reflux disease. H. pylori eradication may decrease the acid-lowering capacity of proton pump inhibitors and H2 receptor antagonists, and it could induce or aggravate gastro-oesophageal reflux. Proton pump inhibitor treatment of gastro-oesophageal reflux disease may be associated with an accelerated development of atrophic gastritis in H. pylori positive patients, suggesting that H. pylori should be diagnosed and eradicated in these patients. The role of H. pylori in duodenogastric reflux remains controversial.