Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 238-243
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.238
Typical and atypical symptoms of gastro esophageal reflux disease: Does Helicobacter pylori infection matter?
Laurino Grossi, Antonio Francesco Ciccaglione, Leonardo Marzio
Laurino Grossi, Antonio Francesco Ciccaglione, Leonardo Marzio, c/o Digestive Sciences Unit, School of Gastroenterology, G. d’Annunzio University Chieti-Pescara, Ospedale Spirito Santo, 65124 Pescara, Italy
Author contributions: Grossi L was the author involved in the conception of the study and drafting the manuscript; Grossi L and Ciccaglione AF performed the exams and obtained the clinical history of patients and interpreted the results; Marzio L supervised the report and gave final approval of the version submitted.
Institutional review board statement: It was not necessary to get an Ethics Committee approval as no drugs or therapeutic techniques have been used in this study. However, the work has been done with the permit of the Ethics Committee of Ospedale Spirito Santo, Pescara, which was fully informed about the research.
Informed consent statement: Patients were not required to give a complete informed consent. All patients recruited into the study had been referred to our Unit to perform a pH-monitoring. They were only interviewed about H. pylori status, without assuming any drugs or testing medical techniques. After receiving full information about the study and giving informed, written consent, each patient underwent C13 Urea Breath test. All patients were reassured about the anonymous characteristics of data recruitments.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Laurino Grossi, MD, Associate Professor, c/o Digestive Sciences Unit, School of Gastroenterology, G. d’Annunzio University Chieti-Pescara, Ospedale Spirito Santo, Via Fonte Romana, 8, 65124 Pescara, Italy. lgrossi@unich.it
Telephone: +39-085-4252460
Received: May 26, 2015
Peer-review started: May 28, 2015
First decision: June 18, 2015
Revised: July 15, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 6, 2015
Processing time: 170 Days and 14.8 Hours
Abstract

AIM: To analyze whether the presence of Helicobacter pylori (H. pylori) infection could affect the quality of symptoms in gastro-esophageal reflux disease (GERD) patients.

METHODS: one hundred and forty-four consecutive patients referred to our Unit for suspected GERD were recruited for the study. All patients underwent esophageal pH-metric recording. For those with a positive test, C13 urea breath test was then performed to assess the H. pylori status. GERD patients were stratified according to the quality of their symptoms and classified as typical, if affected by heartburn and regurgitation, and atypical if complaining of chest pain, respiratory and ears, nose, and throat features. H. pylori-negative patients were also asked whether they had a previous diagnosis of H. pylori infection. If a positive response was given, on the basis of the time period after successful eradication, patients were considered as “eradicated” (E) if H. pylori eradication occurred more than six months earlier or “recently eradicated” if the therapy had been administered within the last six months. Patients without history of infection were identified as “negative” (N). χ2 test was performed by combining the clinical aspects with the H. pylori status.

RESULTS: one hundred and twenty-nine of the 144 patients, including 44 H. pylori-positive and 85 H. pylori-negative (41 negative, 21 recently eradicated, 23 eradicated more than 6 mo before), were eligible for the analysis. No difference has been found between H. pylori status and either the number of reflux episodes (138 ± 23 vs 146 ± 36, respectively, P = 0.2, not significant) or the percentage of time with pH values < 4 (6.8 ± 1.2 vs 7.4 ± 2.1, respectively, P = 0.3, not significant). The distribution of symptoms was as follows: 13 typical (30%) and 31 atypical (70%) among the 44 H. pylori-positive cases; 44 typical (52%) and 41 atypical (48%) among the 85 H. pylori-negative cases, (P = 0.017 vs H. pylori+; OR = 2.55, 95%CI: 1.17-5.55). Furthermore, clinical signs in patients with recent H. pylori eradication were similar to those of H. pylori-positive (P = 0.49; OR = 1.46, 95%CI: 0.49-4.37); on the other hand, patients with ancient H. pylori eradication showed a clinical behavior similar to that of H. pylori-negative subjects (P = 0.13; OR = 0.89, 95%CI: 0.77-6.51) but different as compared to the H. pylori-positive group (P < 0.05; OR = 3.71, 95%CI: 0.83-16.47).

CONCLUSION: Atypical symptoms of GERD occur more frequently in H. pylori-positive patients than in H. pylori-negative subjects. In addition, atypical symptoms tend to decrease after H. pylori eradication.

Keywords: Eradication; Helicobacter pylori; C13 urea breath test; Symptoms; Gastro-esophageal reflux disease; pH-metry

Core tip: This study aimed to investigate whether the presence of Helicobacter pylori (H. pylori) infection could affect the symptom pattern of patients with gastro-esophageal reflux disease (GERD). GERD patients with H. pylori were predominantly affected by atypical symptoms (chest pain, respiratory and ears, nose, and throat features) whilst patients without infection mainly referred typical GERD symptoms (heartburn, regurgitation). Therefore, it seems reasonable to assume that H. pylori infection may have a role in GERD pathogenesis or at least in the modulation of symptoms appearance.