The role of Helicobacter pylori and CagA in response to treatment in Iranian gastroesophageal reflux disease patients

Aim: This study was conducted to evaluate the influence of H. pylori infection and anti-CagA status on the efficacy of omeperazole 20 m.g. b.d. for patients with endoscopic oesophagitis. Background: The influence of Helicobacter pylori (H. pylori) infection and its virulent strain (cytotoxin-associated gene A: CagA) has not been evaluated on the efficacy of treatment for patients with erosive oesophagitis in Iran. Patients and methods: One hundred and ten patients (55 H. Pylori positive and 55 H. Pylori negative) with endoscopic evidence of oeosphagitis were enrolled in this interventional study and treated with omeprazole 20 m.g. b.d. Healing was assessed at repeat endoscopy after 8 weeks of treatment. H. Pylori infection and anti-CagA-IgG (immunoglobulin G) antibodies were determined for each subject by the rapid urease test, pathological assessment and ELISA. Results: At repeat endoscopy, following 8 weeks of omeprazole 20 m.g. b.d. therapy, endoscopic healing of oesophagitis had occurred in 32% of the HP +ve patients and 23% of the HP -ve patients (chi square p 0.01). Among the HP +ve endoscopic healing occurred in 11 (32.4%) of the CagA +ve patients and 19 (90.5%) of the CagA -ve patients. This difference was significant (chi-square p 0.001). Conclusion: H. pylori infection and the CagA virulence factor are associated with an increased rate of healing amongst patients with endoscopic oesophagitis treated with omperazole 20 m.g. b.d. compared to patients without H. pylori infection. © 2013 RIGLD.