Editorial
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World J Gastroenterol. Feb 14, 2013; 19(6): 786-789
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.786
Helicobacter pylori eradication and reflux disease onset: Did gastric acid get "crazy"?
Angelo Zullo, Cesare Hassan, Alessandro Repici, Vincenzo Bruzzese
Angelo Zullo, Cesare Hassan, Vincenzo Bruzzese, Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy
Alessandro Repici, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, 00100 Milan, Italy
Author contributions: Zullo A and Hassan C designed and edited the review; Repici A reviewed literature; Bruzzese V contributed with constructive criticisms.
Correspondence to: Dr. Angelo Zullo, MD, Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Via E. Morosini 30, 00153 Roma, Italy. zullo66@yahoo.it
Telephone: +39-6-58446533 Fax: +39-6-58446608
Received: May 4, 2012
Revised: July 6, 2012
Accepted: July 18, 2012
Published online: February 14, 2013
Abstract

Gastroesophageal reflux disease (GORD) is highly prevalent in the general population. In the last decade, a potential relationship between Helicobacter pylori (H. pylori) eradication and GORD onset has been claimed. The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis. We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field. Oesophagitis onset after H. pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion, which could develop following body gastritis healing. However, the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies. Indeed, duodenal ulcer recurrence is virtually abolished following H. pylori eradication. In addition, intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication. Moreover, oesophageal manometric studies suggest that H. pylori eradication would reduce - rather than favor - acid reflux into the oesophagus. Finally, data of clinical studies would suggest that H. pylori eradication is not significantly associated with either reflux symptoms or erosive oesophagitis onset, some data suggesting also an advantage in curing the infection when oesophagitis is already present. Therefore, the legend of “crazy acid” remains - as all the others - a fascinating, but imaginary tale.

Keywords: Helicobacter pylori; Oesophageal reflux; Oesophagitis; Eradication; Pathophysiology; Clinical studies