Rodrigues Lino, Faria Cintya Miler de, Geocze Stephan, Chehter Luiz
Universidade Federal de São Paulo, Brasil.
Arq Gastroenterol. 2012 Jan-Mar;49(1):56-63. doi: 10.1590/s0004-28032012000100010.
Helicobacter pylori has been associated with worsening of gastroesophageal reflux disease (GERD).
To evaluate the effect of H. pylori eradication in GERD patients.
We conducted a prospective, randomized, controlled trial performing symptom evaluation, endoscopy, histology, manometry and esophageal pH testing on GERD patients. Patients infected with H. pylori were randomized to: 1) eradication treatment plus proton pump inhibitors treatment, or 2) proton pump inhibitors alone. Patients not infected constituted a negative control group. After 3 months, patients were re-evaluated by symptom assessment, endoscopy, histology and manometry.
GERD treatment resulted in significantly higher lower esophageal sphincter pressure, as measured by mean expiratory pressure, in H. pylori negative patients. There was significantly lower proportion of hypotensive waves and significantly higher proportion of normotensive waves in non-eradicated patients. All symptom scores were significantly reduced in the post-treatment period compared to baseline, to values that were similar among the three groups, in the post-treatment period. In the post-treatment period, erosive esophagitis was significantly less frequent on those not eradicated.
Manometric, clinical and endoscopic data showed no benefit in eradicating H. pylori in GERD. Our data supports the hypothesis that H. pylori eradication does not influence GERD.
幽门螺杆菌与胃食管反流病（GERD）的病情恶化有关。
评估根除幽门螺杆菌对GERD患者的影响。
我们进行了一项前瞻性、随机、对照试验，对GERD患者进行症状评估、内镜检查、组织学检查、测压和食管pH值检测。感染幽门螺杆菌的患者被随机分为：1）根除治疗加质子泵抑制剂治疗，或2）单独使用质子泵抑制剂。未感染的患者组成阴性对照组。3个月后，通过症状评估、内镜检查、组织学检查和测压对患者进行重新评估。
通过平均呼气压力测量，GERD治疗使幽门螺杆菌阴性患者的食管下括约肌压力显著升高。未根除幽门螺杆菌的患者中，低血压波的比例显著降低，正常血压波的比例显著升高。与基线相比，治疗后所有症状评分均显著降低，治疗后三组之间的症状评分值相似。在治疗后阶段，未根除幽门螺杆菌的患者中糜烂性食管炎的发生率显著降低。
测压、临床和内镜数据显示，根除幽门螺杆菌对GERD没有益处。我们的数据支持根除幽门螺杆菌不影响GERD的假说。
