Gisbert J P, de Pedro A, Losa C, Barreiro A, Pajares J M
Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain.
J Clin Gastroenterol. 2001 Mar;32(3):210-4. doi: 10.1097/00004836-200103000-00005.
The precise role of Helicobacter pylori infection in gastroesophageal reflux disease (GERD) is a matter of intense debate. Twenty-four-hour esophageal pH monitoring has a higher accuracy than endoscopy for the diagnosis of GERD, but the correlation between H. pylori infection and esophageal pH-metric parameters has almost never been assessed. Therefore, we evaluated the relationship between the infection and the presence of disturbances not only in endoscopy but also in 24-hour esophageal pH monitoring. One hundred consecutive patients undergoing 24-hour esophageal pH monitoring because of symptoms suggestive of GERD were included in the study. Esophageal manometry was carried out to study the position and the pressure of the lower esophageal sphincter (LES). Prevalence of H. pylori infection was evaluated by histology (hematoxylin and eosin stain) and rapid urease test. The mean age of the patients was 50 +/- 15 years; 50% were men and 56% had an abnormal pH-metry (DeMeester score more than 14.7). The prevalence of H. pylori in patients with abnormal pH-metry was 57% (95% CI, 42-70%) and was 52% (95% CI, 39-64%) in those with normal pH-metry (nonsignificant differences [NS]). In the multivariate analysis, H. pylori infection did not correlate with an abnormal pH-metry (odds ratio, 0.8; 95% CI, 0.4-1.8; NS). The proportion of cases with abnormal pH-metry among infected patients was 54% (95% CI, 41-66%) and was 59% (95% CI, 44-72%) among uninfected patients (NS). Mean values of pH-metric parameters (+/-SD), respectively for H. pylori-positive and -negative patients, were total score (30 +/- 33 vs. 36 +/- 38), number of reflux episodes (7 +/- 7 vs. 11 +/- 11), number of episodes more than 5 minutes (3.7 +/- 5 vs. 3.8 +/- 5), longest reflux episode (2.4 +/- 2 minutes vs. 3.1 +/- 3 minutes), and fraction time (%) with pH less than 4 (total, 6 +/- 7 vs. 6.8 +/- 8; upright, 3.9 +/- 4 vs. 4.5 +/- 5; supine, 7.4 +/- 12 vs. 7.2 +/- 10) (all findings were NS). Endoscopic findings, respectively for H. pylori-positive and -negative, were hiatus hernia (41% vs. 41%), endoscopic esophagitis (Savary-Miller) (54% vs. 46%), and Barrett's esophagus (15% vs. 11%) (all findings were NS). Finally, differences were not demonstrated in the pressure of the lower esophageal sphincter (12 +/- 8 mmHg vs. 14 +/- 12 mmHg) among H. pylori-positive and -negative patients. H. pylori infection is not associated with gastroesophageal reflux disease, as evaluated endoscopically and with 24-hour esophageal pH monitoring.
幽门螺杆菌感染在胃食管反流病（GERD）中的精确作用是一个激烈争论的话题。24小时食管pH监测在GERD诊断方面比内镜检查具有更高的准确性，但幽门螺杆菌感染与食管pH测量参数之间的相关性几乎从未被评估过。因此，我们不仅评估了感染与内镜检查结果之间的关系，还评估了其与24小时食管pH监测中紊乱情况的关系。该研究纳入了100例因GERD症状而接受24小时食管pH监测的连续患者。进行食管测压以研究食管下括约肌（LES）的位置和压力。通过组织学（苏木精和伊红染色）和快速尿素酶试验评估幽门螺杆菌感染的患病率。患者的平均年龄为50±15岁；50%为男性，56%的pH测量结果异常（DeMeester评分超过14.7）。pH测量异常患者中幽门螺杆菌的患病率为57%（95%CI，42 - 70%），pH测量正常患者中为52%（95%CI，39 - 64%）（无显著差异[NS]）。在多变量分析中，幽门螺杆菌感染与pH测量异常无相关性（比值比，0.8；95%CI，0.4 - 1.8；NS）。感染患者中pH测量异常的病例比例为54%（95%CI，41 - 66%），未感染患者中为59%（95%CI，44 - 72%）（NS）。幽门螺杆菌阳性和阴性患者的pH测量参数平均值（±标准差）分别为总分（30±33对36±38）、反流发作次数（7±7对11±11）、超过5分钟的发作次数（3.7±5对3.8±5）、最长反流发作时间（2.4±2分钟对3.1±3分钟）以及pH值小于4的时间百分比（总计，6±7对6.8±8；直立位，3.9±4对4.5±5；仰卧位，7.4±12对7.2±10）（所有结果均为NS）。幽门螺杆菌阳性和阴性患者的内镜检查结果分别为食管裂孔疝（41%对41%）、内镜下食管炎（Savary - Miller分级）（54%对46%）和巴雷特食管（15%对11%）（所有结果均为NS）。最后，幽门螺杆菌阳性和阴性患者之间食管下括约肌压力（12±8 mmHg对14±12 mmHg）无差异。在内镜检查和24小时食管pH监测评估中，幽门螺杆菌感染与胃食管反流病无关。
