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Eradication of Helicobacter pylori Confers no Significant Benefit for Patients with Heartburn or Gastroesophageal Reflux

Helicobacter pylori infection appears associated with a small increased prevalence of heartburn but not with gastroesophageal reflux, however, eradication of H pylori does not offer a significant benefit for patients with either condition, according to findings from the Bristol helicobacter project.

Richard F. Harvey, consultant gastroenterologist, Frenchay Hospital, Bristol, United Kingdom, and colleagues assessed data on the frequency and severity of any epigastric pain, heartburn, and gastro-oesophageal reflux 1634 adult participants positive for H pylori infection compared with 3268 participants negative for the infection.

Among those with H pylori, 95.3% were randomised to receive active treatment (n=787), which included 500 mg clarithromycin and 400 mg ranitidine bismuth citrate twice daily for 2 weeks, or placebo (n=771). At 6 months, 90.7% of those who received active treatment and 14.0% of those treated with placebo were negative for H pylori, but these results remained blinded until completion of the 2-year follow up.

Among participants who had H pyloriinfection 50.1% reported heartburn in the past 3 months and 28.1% reported heartburn at least monthly compared with 47.1% and 25.2%, respectively, of the uninfected participants. In the infected group, 40.0% reported acid reflux in the past 3 months and 18.6% reported acid reflux at least monthly compared with 37.4% and 17.4%, respectively, in those without infection.

Overall, H pylori eradication had no significant effect on the prevalence of either heartburn or gastro-oesophageal reflux, the authors note, with respective odds ratios of 0.99 and 1.04.

Treatment did not impact the development of heartburn - odds ratio 0.90 - or the development of reflux - odds ratio 1.05 - in previously asymptomatic participants. Participants with symptoms at baseline showed no significant improvement in heartburn or reflux - odds ratios of 0.90 and 0.89, respectively - with treatment.

Among the 248 participants with gastro-oesophageal reflux but not heartburn at baseline, H pylori eradication was slightly protective ? odds ratio 0.56 ? against developing heartburn over the 2-year follow up.

These findings suggest, "H pylori is associated with an increased prevalence of heartburn and that H pylori eradication treatment reduces the risk of patients with acid reflux developing heartburn," the authors conclude. However, the findings reveal that H pylori eradication had no benefit on the symptoms of gastro-oesophageal reflux disease.

BMJ, doi:10.1136/bmj.38082.626725.EE (published 4 May 2004)

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