Indications for HP eradication: gastro-esophageal reflux disease.

HP infection of the stomach is not a risk factor for reflux oesophagitis, and may even protect against reflux oesophagitis. HP eradication may lead to an accelerated development of GERD in duodenal ulcer disease patients. It is unknown whether this is also true for HP positive patients who do not suffer from duodenal ulcer disease. HP eradication may decrease the efficacy of acid secretion lowering drugs such as Proton Pump Inhibitors and H2-Receptor Antagonists. It is unclear whether this has any practical consequences, but it cannot be excluded that some patient may need an increased dose of acid secretion lowering drugs after HP eradication for control of symptoms and lesions of GERD. There are conflicting data on the possibility that long-term proton pump inhibitor treatment may accelerate the development of atrophic gastritis in Helicobacter pylori positive patients. The possible acceleration of atrophic gastritis development in HP positive patients using strong acid secretion inhibitors is the strongest argument in favour of eradicating HP in patients receiving long term potent acid inhibition, especially GERD patients. In view of the uncertainty concerning these data, both eradicating and non eradicating HP in patients with GERD can be defended.