Helicobacter pylori, proton pump inhibitors and gastroesophageal reflux disease

Yale J Biol Med. 1999 Mar-Jun;72(2-3):211-8.

Abstract

Proton pump inhibitors have become of pivotal importance for the treatment of GERD. The purpose of this paper is to review the interaction between Helicobacter pylori and PPIs in the treatment of GERD. H. pylori exaggerates the acid suppressive effects of PPIs. During treatment with these drugs, H. pylori-positive subjects thus have a higher intragastric pH than H. pylori-negative subjects. The mechanism for this phenomenon remains to be elucidated. We hypothesize that it is related to H. pylori-induced corpus gastritis, which impairs parietal cell function. The available evidence suggests that this phenomenon has no clinical relevance for the treatment of GERD. The 24-hr esophageal pH during PPI treatment does not depend on the H. pylori status, nor does the medication dose needed for maintenance therapy or the number of clinical relapses during such therapy depend on the H. pylori status. PPIs, on the other hand, also affect H. pylori. During treatment with these drugs, the pattern of bacterial colonization and associated gastritis shifts proximally. The increased gastritis of the body mucosa is associated with a more rapid development of atrophic gastritis, a condition characterized by a loss of gastric glands and associated with an increased cancer risk. For these reasons, one has to consider H. pylori eradication in infected GERD patients in need of PPI maintenance therapy.

Publication types

  • Review

MeSH terms

  • Gastric Juice
  • Gastritis, Atrophic / chemically induced
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / microbiology
  • Gastrointestinal Diseases / drug therapy
  • Gastrointestinal Diseases / etiology
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / etiology
  • Helicobacter pylori / drug effects*
  • Humans
  • Hydrogen-Ion Concentration
  • Proton Pump Inhibitors*
  • Proton-Translocating ATPases / antagonists & inhibitors

Substances

  • Proton Pump Inhibitors
  • Proton-Translocating ATPases