The Association and Clinical Implications of Gastroesophgeal Reflux Disease and H. pylori

The relationship between GERD and H. pylori is complex and negatively associated with important implications for both individual patients and the nations of the world. Whereas the incidence of GERD and its complications, including Barrett's esophagus and adenocarcinoma of the esophagus and gastric cardia have increased, the incidence of H. pylori related gastroduodenal peptic ulcer disease and distal gastric adenocarcinoma has decreased in Western Europe and the United States. This suggests an inverse, negative, relationship between the two. H. pylori infection eradication does not cause GERD, but there is possibly a protective and negative effect of H. pylori in patients with GERD which is related to the virulence of the infecting strain and the distribution and severity of gastritis. It remains controversial whether or not to test and treat for the infection of H. pylori with respect to the direct management of GERD, because of its potentially protective effect. However, in patients who require long term therapy with PPI agents, a test and treat strategy may be appropriate, since PPI therapy might increase the risk of atrophic gastritis and its potential for B-12 malabsorption and gastric cancer in H. pylori infected individuals. If the prevalence of H. pylori decreases in the developing countries of the world, one may anticipate that there will be a decrease in incidence of cancer of the gastric body and antrum and an increase in the prevalence of GERD and incidence of adenocarcinoma of the esophagus and gastric cardia over the next few decades. This is an evolving area with important implications for individual patients as well as for the nations of the world.