Antagonist: Should we eradicate Helicobacter pylori before long term antireflux therapy?

Helicobacter pylori infection invariably induces chronic active gastritis which can give rise to serious consequences such as peptic ulcer and gastric malignancies. Generally accepted indications for treatment are H pylori associated peptic ulcer disease and early stages of low grade mucosa associated lymphoid tissue lymphoma of the stomach. In contrast, treatment of H pylori in patients with gastro-oesophageal reflux disease (GORD) requiring long term treatment with a proton pump inhibitor (PPI) has not yet been put on a scientific footing. In support of this indication in patients with GORD and no associated ulcer disease, the following theoretical arguments might be advanced. In contrast, treatment of H pylori in patients with gastro-oesophageal reflux desease (GORD) requiring long term treatment with a proton pump inhibitor (PPI) has not yet been put on a scientific footing. In support of this indication in patients with GORD and no associated ulcer disease, the following theoretical arguments might be advanced. (1) H pylori is involved in the pathogenesis of GORD so that eradication of this organism would lead to an improvement in, or even elimination of, GORD. (2) Eradication of H pylori infection is associated with an improvement in the eVectiveness of treatment with PPI in patients with GORD. (3) PPI treatment of GORD carries a higher risk in patients with H pylori infection than in H pylori negative patients, and this risk can be eliminated by eradication of the infection.