Helicobacter pylori eradication increases GERD risk in PUD
MedWire News: Eradication of Helicobacter pylori increases the risk for gastroesophageal reflux disease (GERD) in patients with peptic ulcer disease (PUD) but not in those with dyspepsia, show results from a meta-analysis.
The findings showed a two-fold increased risk for erosive GERD in patients with PUD who had undergone H. pylori eradication.
Richard Hunt (McMaster University Health Sciences Centre, Ontario, Canada) and colleagues report the results of a meta-analysis of 12 studies (seven randomized controlled trials [RCTs] and five cohort studies) assessing the influence of H. pylori eradication on GERD development that included a total of 4058 participants in total.
Seven studies had a follow-up period lasting 12 months or more, four had a follow-up period lasting less than 12 months, and one study did not precisely define the length of study period.
To be included in the meta-analysis, RCTs of patients with H. pylori had to compare eradication therapy with placebo, and patients had to be tested for efficacy of eradication therapy at study completion, after which they were followed-up for GERD onset.
Cohort studies had to include patients with H. pylori, but no prior GERD, who were given eradication therapy and then tested for efficacy of H.pylori eradication at study completion.
Of the total pooled cohort, 1281 patients achieved H.pylori eradication and 2699 had persistent H. pylori. The incidence of erosive GERD during follow-up was not significantly different between those who achieved eradication of H.pylori and those who did not.
When subgroups were compared, such as cohort versus RCT studies, high-quality versus low-quality studies, and patients with dyspepsia alone versus PUD at baseline, only patients with PUD in the cohort studies had a significantly increased risk for erosive GERD following H. pylori eradication.
In four cohort studies that included patients with PUD, those in the H. pylori eradicated group were 2.04 times more likely to develop erosive GERD during follow-up than those in the persistent H. pylori group. This pattern was also present in the RCTs, but was not statistically significant.
“The higher frequency of GERD after H. pylori eradication in patients with PUD might be due to a higher baseline acid secretion compared with those with persistent infection leading to the development of GERD in those with other predisposing factors,” suggest Hunt and co-authors.
“A lower frequency of H. pylori-induced atrophic gastritis and hypochlorhydria after eradication might be another factor that could affect the frequency of GERD,” they add.
The results of this study are published in the American Journal of Gastroenterology.
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By Helen Albert