Correlation between Helicobacter pylori infection and reflux esophagitis: still an ongoing debate

Abstract

Context The vast majority of pathologies in the oesophagus, stomach and duodenum are related to either H. pylori infection or gastro-oesophageal reflux disease (GERD). Both conditions affect a large proportion of the population and they may occur either independently or concomitantly. The question of whether the two conditions are mutually exclusive, synergistic, or simply independent is an issue that was raised several years ago and is a matter of ongoing debate. Aim We aimed to determine the correlation between gastric Helicobacter colonization and grossly and histologically proven reflux esophagitis. Settings and design This work was designed as a descriptive cross-sectional study. Patients and methods The study was conducted on 50 patients, five women and 45 men, aged 19–79 years (mean: 35.3 years). The inclusion criterion was having a history of symptoms suggestive of GERD. The cases were chosen from among outpatients and inpatients undergoing diagnostic endoscopic study at the endoscopy unit. The main presenting complaints were GERD symptoms, dyspepsia and postprandial epigastric pain. All cases were subjected to thorough history taking regarding the details and nature of the presenting complaint, special habits including caffeine consumption, smoking, and intake of medications such as antacids and H2 blockers, complete physical examination and upper endoscopy. Detailed description of upper endoscopic examination was reported, including the grade of esophagitis according to Savary–Miller classification. Three groups of biopsies were taken from each case: the first set from the lower end of the oesophagus and the two other sets from the gastric antrum. The oesophageal biopsies and one set of gastric biopsies were examined histologically after being processed. The second gastric biopsy set was used for direct detection of H. pylori using the rapid urease test (Campylobacter-like organism test). The rapid urease test offers a sensitivity of 80–99% and a specificity of 92–100% in untreated patients when compared with histology as the gold standard in the diagnosis of H. pylori infection. Statistical analysis Data were statistically described in terms of frequencies (number of cases) and percentages and compared using the χ2-test. The exact test was used when the expected frequency was less than 5. Results On using the rapid urease enzyme test there were 44 (88%) positive cases and six (12%) negative cases for H. pylori. By direct histopathologic examination there were 32 (64%) positive cases and 18 (36%) negative cases for H. pylori. There was no statistically significant correlation between gastric colonization with H. pylori and reflux esophagitis diagnosed grossly and histopathologically. Conclusion The study showed no statistically significant correlation between H. pylori infection and the presence of reflux esophagitis.

Keywords

• H. pylori
• reflux esophagitis