Review article: Helicobacter pylori and gastro-oesophageal reflux disease--the European perspective.

There is substantive epidemiological evidence of a negative association between Helicobacter pylori infection and reflux disease and its malignant complications. A plausible mechanism by which the infection might protect against reflux disease is by its propensity to produce atrophic gastritis and consequently reduce gastric acid secretion. Gastric acid is a key factor in the pathophysiology of reflux oesophagitis. It is well recognised that acid secretion decreases with age in H. pylori infected populations whereas acid secretion is maintained throughout life in H. pylori negative populations. The tendency for H. pylori infection to induce atrophy and reduce acid secretion is more marked in Eastern Europe and the Far East than in Western Europe, and this may be due to the influence of environmental and host genetic co-factors. This difference may also explain why the negative association between H. pylori infection and reflux disease is more marked in these areas than in Western Europe. If H. pylori infection is indeed protecting against reflux disease, then one would predict a rise in incidence of this disease and its malignant complications in these Eastern countries as the incidence of H. pylori infection decreases.