Associations between H pylori infection and GERD

Paul Moayyedi, MB, is a gastroenterologist and professor of medicine at McMaster University. He has served as director of the Division of Gastroenterology and president of the Canadian Association of Gastroenterology. He conducted large randomized controlled trials and observational studies in the areas of gastroesophageal reflux disease, Barrett esophagus, Helicobacter pylori, functional gastrointestinal disease, and inflammatory bowel diseases.

Is there any association between Helicobacter pylori infection and gastroesophageal reflux disease (GERD)? Should patients be tested for Helicobacter pylori infection and receive eradication treatment (if the results are positive) before initiating proton pump inhibitors (PPIs)?

Paul Moayyedi, MB: I’ve been involved in 2 randomized clinical trials (RCTs) that have not shown any association between H pylori eradication and reflux. Observational studies had suggested that treating H pylori can make reflux worse, but as I say, RCTs don’t support that. So, there is no indication for H pylori eradication to manage reflux symptoms.

However, there are many other reasons to treat H pylori. If you have a family history of gastric cancer, you should have a treatment for the infection. There is also a theoretical risk that if you have H pylori infection and you will give it a PPI, that changes the topography of the infection from an antrum-predominant to a pangastritis-type picture, and the latter type is more associated with gastric cancer.

So, at least theoretically, it may be recommended to treat H pylori, but most guidelines would not suggest that testing before giving PPI therapy, because the risk is purely theoretical at this stage, and so you would only test for and eradicate H pylori for specific indications.