Role of Helicobacter Pylori in the Pathogenesis of Lower Esophageal Diseases

Helicobacter pylori (H. pylori) infection and gastro-esophageal reflux disease (GERD) affect a large proportion of the population and they may occur either concomitantly or independently. The question of whether the two conditions are mutually exclusive, synergistic or simply independent is an issue that has been raised several years ago and is a matter of ongoing debate.Aim: The aim of this work is to determine the role of H. pylori infection in the pathogenesis of lower esophageal diseases mainly reflux esophagitis, so as to further verify the complex interrelation between both diseases.Patients and Methods: The study included 30 patients presenting to the Endoscopy Unit of Kasr El-Aini Hospital, Cairo University, complaining of upper gastro-intestinal (GI) symptoms and in whom upper endoscopy revealed signs of reflux esophagitis. Grading of reflux esophagitis was done according to the Los Angeles classification system. Chromoen- doscopy technique was used to guide the biopsy site if Barrett s esophagus was suspected. Biopsies (two from each site) were obtained from esophagus just above the Z-line from the mucosal breaks, from cardia just below the Z-line, gastric body and gastric antrum and were examined histopathologically after staining with hematoxylin and eosin. Clinical, endoscopic and histopathological data were collected, tabulated and statistically analyzed.Results: The age of the patients ranged from 24 to 80 years (mean±SD; 47.43±14.43 years). They were 23 males (76.7%) and 7 females (23.3%). Of the examined group, 12 patients (40%) proved to be H. pylori positive and 18 patients (60%) proved to be H. pylori negative and the difference was not statistically significant (p=0.667). There was no significant relation between H. pylori status and any of the demographic features, the clinical symptoms or the presence of hiatus hernia. There was no statistically significant difference in the severity of reflux esophagitis between H. pylori positive and negative patients (p=0.470) and no significant relation was found between H. pylori status and the presence of Barrett s esophagus (p-1). There was also no significant relation between the grade of reflux and H. pylori colonization of the cardia (p=0.054).Conclusion: H. pylori negative status may be associated with a more increased risk of GERD. There is no significant relation between H. pylori status and the endoscopic grade of reflux esophagitis or the presence of Barrett s esophagus. Further studies with larger number of patients are needed.