Barrett’s Esophagus, Erosive Esophagitis, GI Symptoms and H. Pylori

Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center 111-D 2215 Fuller Rd. Ann Arbor, MI 48105MedicalResearch.com Interview with:
Joel H. Rubenstein, MD, MSc, FACG, FASGE
Research Scientist, Veterans Affairs Center for Clinical Management Research
Assistant Professor, Division of Gastroenterology, University of Michigan Medical School
VA Medical Center Ann Arbor, MI 48105
MedicalResearch.com: What are the main findings of the study?

Dr. Rubenstein: In a set of case-control studies within the same population, we found that H. pylori was inversely associated with erosive esophagitis, and with Barrett’s esophagus, but we did not find such a relation with symptoms of gastroesophageal reflux disease (GERD).

MedicalResearch.com Were any of the findings unexpected?

Dr. Rubenstein: Infection with H. pylori has been inversely associated with esophageal adenocarcinoma, and its precursor, Barrett’s esophagus, in many studies.  The prevailing hypothesis accounting for that relationship has been that H. pylori infecting the body of the stomach leads to diminished gastric acid production, and hence decreased GERD.  However, there is no direct evidence that such a mechanism explains the inverse association of H. pylori with Barrett’s esophagus or the cancer.  In addition, in most individuals infected with H. pylori in Western populations, the infection is limited to the antrum of the stomach, which could actually lead to increased gastric acid production.  Our results confirmed the expected inverse association of H. pylori with Barrett’s esophagus, and with erosive esophagitis, but suggest that mechanisms other than diminished GERD may be responsible.

MedicalResearch.com What should clinicians and patients take away from your report?

Dr. Rubenstein: Our study was an epidemiologic one, and not focused on treatment.  However, for clinicians, this study should serve as a reminder that H. pylori is not associated with GERD symptoms.  In geographic regions where gastric cancer is not endemic, testing and treating for H. pylori in individuals without gastric ulcers or dyspepsia is unlikely to help them, and could potentially harm them since H. pylori might protect against esophageal cancer.

MedicalResearch.com What recommendations do you have for future research as a result of this study?

Dr. Rubenstein: Other potential mechanisms for the inverse association of H. pylori with Barrett’s esophagus and esophageal adenocarcinoma need to be explored.  For instance, we previously found that extracted DNA from H. pylori directly down-regulated inflammatory responses in a mouse model of colitis; perhaps H. pylori DNA refluxed into the esophagus has a similar anti-inflammatory effect.  Perhaps H. pylori itself is not responsible; instead there might other associated differences in esophageal or gastric microbiota that are responsible.  Similarly, there might be host genetic differences (such as in genes regulating inflammatory responses) that simultaneously predispose to infection with H. pylori and protect against Barrett’s esophagus.

Citation:

Association between Helicobacter pylori and Barrett’s Esophagus, Erosive Esophagitis, and Gastroesophageal Reflux Symptoms.

Rubenstein JH, Inadomi JM, Scheiman J, Schoenfeld P, Appelman H, Zhang M, Metko V, Kao JY.

Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI; Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.

Clin Gastroenterol Hepatol. 2013 Aug 26. pii: S1542-3565(13)01231-7. doi: 10.1016/j.cgh.2013.08.029. [Epub ahead of print]

 

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