HELICOBACTER PYLORI INFECTION, EROSIVE REFLUX ESOPHAGITIS, AND ATROPHIC GASTRITIS Nguyen Thi Nha Doan MD Lecturer, Internal Medicine Department Ho Chi Minh City University of Medicine and Pharmacy Introduction Reflux esophagitis is believed to occur in approximately 10% of patients who undergo eradication therapy.(*) Some epidemiological reports show an inverse relationship between H pylori infection and reflux esophagitis or Barrett’s esophagus.(**) Conflicting results of meta-analyses and RCTs for H pylori eradication on GERD.(**) Eradication of the H pylori infection may be a risk factor for de-novo endoscopic GERD, especially in Asian populations.(**) (*)Frontiers in Microbiology, June 2015 | Volume | Article 566 (**)Hindawi Publishing Corporation Gastroenterology Research and Practice Volume Đặt vấn đề DU, no RE, Hp(+), eradication n=244 DU, no RE, Hp(+), no eradication n= 216 Endoscopy at 1, 2, years RE within years 25.8% vs 12.9% Pt with RE had more severe body gastritis before cure OR=5.5(2.813.6), gain weight OR=3.2; 95% CI, 1.2–9.4 DU treated for H pylori will devoloped RE risk factor : men, body gastritis, weight gian Labenz, Gastroenterology 1997;112:1442–1447 Study Type of study Locati Number of cases in on each group (𝑛) H pylori H pylori prevalence infection (%) in each group assessmen ts Chung CaseKorea Reflx esophagitis Serology Reflx esophagitis et al control (2,808) (38.4) 2011 Control (2,808) Control (58.2) Gunji et Cross- Japan Erosive esophagitis Serology Erosive esophagitis al 2011 section (1,831) (13.6) al No erosive esophagitis No erosive esophagitis (8,009) (33.4) Chiba et Cross- Japan Erosive esophagitis Serology Erosive esophagitis al 2012 section (728) (9.4) al No erosive esophagitis No erosive esophagitis (4,262) (14.9) Ashktor CaseAmeric Reflx esophagitis (58) Biopsy silver Reflx esophagitis (3.8) ab et al control a Gastritis (1,558) stain or Gastritis (40) 2012 Reflx esophagitis and immunohisto Reflx esophagitis and gastritis (363) chemistry gastritis (34) Normal control (41) Normal control (34) Thrift et CaseAustrili Simple Barrett’s Serology Simple Barrett’s al control a esophagus (217) esophagus (12) 2012 Dysplastic Barrett’s Dysplastic Barrett’s esophagus (95) esophagus (3) Hindawi Publishing Corporation Gastroenterology Research and Practice Stud y Studi Location of es enrolled studies Risk ratio (95% confience interval) Conclusion Xie et al 2013 12 cohor t studie s and 12 RCTs type A cohort studies: 2.50 (1.46– 4.26, = 0.0008) type B cohort studies: 1.70 (1.30– 2.23, = 0.0001) 12 RCTs: 1.09 (1.23– 3.22, = 0.005) Asian RCTs: 4.53 (1.66–12.36, = 0.003) Eradication of the infection may be a risk factor for de novo endoscopic GERD, especially in Asian populations Yagho obi et al 2010 cohor t studie s and RCTs Cohort Europe: North America: Asia: RCTs Europe: South America: Asia: Cohort cohort studies: 1.37 Thre is no Europe: (0.89–2.12, = 0.15) association Asia: RCTs using erosive between H pylori RCTs GERD as outcome: 1.11 eradication and Europe: (0.81–1.53, = 0.52) development North America: RCTs using of new cases of symptomatic GERD as GERD in the South America: outcome: 1.22 (0.89– Research population of Hindawi Publishing Corporation Gastroenterology and Practice Stud y Studi Location of es enrolled studies Risk ratio (95% confience interval) Conclusion Qian et al 2011 11 RCTs Europe: North America: South America: Asia: Multinational: RCTs using heartburn symptom as outcome: 0.88 (0.63– 1.23, = 0.46) 10 RCTs using erosive esophagitis as outcome: 0.97 (0.67–1.40, = 0.88) H pylori eradication does not aggravate the clinical outcomes in terms of short-term and long-term posteradication occurrence of GERD Saad et al 2012 10 RCTs Europe: North America: Asia: 10 RCTs using symptomatic GERD as outcome: 0.81 (0.56– 1.71, = 0.27) 10 RCTs using endoscopic esophagitis as outcome: 1.13 (0.72– 1.78, = 0.59) Treatment of H pylori does not seem to increase GERD symptoms or reflx esophagitis However, documented eradication of H pylori appears to signifiantly Hindawi Publishing Corporation Gastroenterology Research and Practice European Journal of Gastroenterology & Hepatology 2013, 25:1195– European Journal of Gastroenterology & Hepatology 2013, 25:1195– Western Europe OR 0,76 CI 95% 0,61 0,96 North American OR 0,70 CI 95% 0,55 - 0,9 Far East OR 0,24 CI 95% 0,19 0,32 Raghunath et al ,BMJ 2003;326:737 Relationships between the location of H pylori-induced gastric inflammation, acid secretion, and disease Antral-predominant gastritis with relative sparing of the acid-secreting corpus leads to increased acid secretion and an increased risk for duodenal ulcer disease Richard M Peek, Jr Dis Model Mech 2008;1:50-55 ©2008 by The Company of Biologists Limited 175 patients with reflux esophagitis were compared with sex- and age-matched 175 control Atrophic gastritis was assessed by histology and serum pepsinogen I/II ratio H pylori-positive atrophic gastritis milder in the patients with reflux esophagitis than in the patients without it The American Journal of Gastroenterology vol 94, no 12, 1999 ... atrophy 122 73,1% 45 26,9% 167 - Mild 422 64,8% 229 35, 2% 651 1,47 1-2,4 Moderate 97 58 ,8% 68 41,2% 1 65 1,9 1,19-3,01 Severe 41,2% 10 58 ,8% 17 3,87 1,39-10,79 CI 95% P 0,008 Results... 0,24 OR 0,39 0,2 0 ,58 0,76 0,70 CI 95% 0,24 0,07 – 0,6 0,63 0 ,58 -0,66 0,61 0,96 0 ,55 - 0,9 0,19 0,32 0,69 0,49 – 0,83 Raghunath et al ,BMJ 2003;326:737 Western Europe OR 0,76 CI 95% 0,61 0,96 North... 44 ± 11 (min 13, max84) H pylori infection 35, 2% Endoscopic gastric atrophy No atrophy C0 (167) 16,7%, Mild C1-C2 ( 651 ) 65, 1%, Moderate C3-O1 (1 65) 16 ,5% , Severe O2-O3 (17) 1,7% Reflux esophagitis