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Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms.
Clin Gastroenterol Hepatol. 2014 Feb; 12(2):239-45.CG

Abstract

BACKGROUND & AIMS

Infection with Helicobacter pylori, particularly the cytotoxin-associated gene A (cagA)+ strain, is believed to protect against Barrett's esophagus, but it is not clear if it protects against gastroesophageal reflux disease (GERD). We aimed to determine whether H pylori infection is associated with GERD symptoms, erosive esophagitis, and Barrett's esophagus within the same cohort.

METHODS

We analyzed data from a case-control study of 533 men (ages, 50-79 y) who underwent colorectal cancer screening at 2 tertiary medical centers in Michigan between 2008 and 2011 and who also were recruited to undergo upper endoscopy. We assessed 80 additional men found to have Barrett's esophagus during clinically indicated upper-endoscopy examinations. Logistic regression was used to estimate the associations between serum antibodies against H pylori or cagA and GERD symptoms, esophagitis, and Barrett's esophagus, compared with randomly selected men undergoing colorectal cancer screens (n = 177).

RESULTS

H pylori infection was associated inversely with Barrett's esophagus (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.97), particularly the cagA+ strain (OR, 0.36; 95% CI, 0.14-0.90). There was a trend toward an inverse association with erosive esophagitis (H pylori OR, 0.63; 95% CI, 0.37-1.08; and cagA+ OR, 0.47; 95% CI, 0.21-1.03). However, GERD symptoms were not associated with H pylori infection (OR, 0.948; 95% CI, 0.548-1.64; and cagA+ OR, 0.967; 95% CI, 0.461-2.03).

CONCLUSIONS

Based on a case-control study, infection with H pylori, particularly the cagA+ strain, is associated inversely with Barrett's esophagus. We observed a trend toward an inverse association with esophagitis, but not with GERD symptoms.

Authors+Show Affiliations

Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: jhr@umich.edu.Division of Gastroenterology, Department of Internal Medicine, University of Washington Medical School, Seattle, Washington.Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan.Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23988686

Citation

Rubenstein, Joel H., et al. "Association Between Helicobacter Pylori and Barrett's Esophagus, Erosive Esophagitis, and Gastroesophageal Reflux Symptoms." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 12, no. 2, 2014, pp. 239-45.
Rubenstein JH, Inadomi JM, Scheiman J, et al. Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol. 2014;12(2):239-45.
Rubenstein, J. H., Inadomi, J. M., Scheiman, J., Schoenfeld, P., Appelman, H., Zhang, M., Metko, V., & Kao, J. Y. (2014). Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 12(2), 239-45. https://doi.org/10.1016/j.cgh.2013.08.029
Rubenstein JH, et al. Association Between Helicobacter Pylori and Barrett's Esophagus, Erosive Esophagitis, and Gastroesophageal Reflux Symptoms. Clin Gastroenterol Hepatol. 2014;12(2):239-45. PubMed PMID: 23988686.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. AU - Rubenstein,Joel H, AU - Inadomi,John M, AU - Scheiman,James, AU - Schoenfeld,Philip, AU - Appelman,Henry, AU - Zhang,Min, AU - Metko,Val, AU - Kao,John Y, Y1 - 2013/08/27/ PY - 2013/04/08/received PY - 2013/08/07/revised PY - 2013/08/09/accepted PY - 2013/8/31/entrez PY - 2013/8/31/pubmed PY - 2014/8/12/medline KW - AAVAMC KW - Ann Arbor Veterans Affairs Medical Center KW - BE KW - Bacteria KW - CI KW - CRC KW - GERD KW - GERQ KW - Gastroesophageal Reflux Questionnaire KW - H2RA KW - IgG KW - Newly Diagnosed Barrett's Esophagus Study KW - OR KW - PPI KW - Stomach KW - cagA KW - colorectal cancer KW - confidence interval KW - cytotoxin-associated gene A KW - gastroesophageal reflux disease KW - histamine-2–receptor antagonist KW - immunoglobulin G KW - odds ratio KW - proton pump inhibitor SP - 239 EP - 45 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin Gastroenterol Hepatol VL - 12 IS - 2 N2 - BACKGROUND & AIMS: Infection with Helicobacter pylori, particularly the cytotoxin-associated gene A (cagA)+ strain, is believed to protect against Barrett's esophagus, but it is not clear if it protects against gastroesophageal reflux disease (GERD). We aimed to determine whether H pylori infection is associated with GERD symptoms, erosive esophagitis, and Barrett's esophagus within the same cohort. METHODS: We analyzed data from a case-control study of 533 men (ages, 50-79 y) who underwent colorectal cancer screening at 2 tertiary medical centers in Michigan between 2008 and 2011 and who also were recruited to undergo upper endoscopy. We assessed 80 additional men found to have Barrett's esophagus during clinically indicated upper-endoscopy examinations. Logistic regression was used to estimate the associations between serum antibodies against H pylori or cagA and GERD symptoms, esophagitis, and Barrett's esophagus, compared with randomly selected men undergoing colorectal cancer screens (n = 177). RESULTS: H pylori infection was associated inversely with Barrett's esophagus (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.97), particularly the cagA+ strain (OR, 0.36; 95% CI, 0.14-0.90). There was a trend toward an inverse association with erosive esophagitis (H pylori OR, 0.63; 95% CI, 0.37-1.08; and cagA+ OR, 0.47; 95% CI, 0.21-1.03). However, GERD symptoms were not associated with H pylori infection (OR, 0.948; 95% CI, 0.548-1.64; and cagA+ OR, 0.967; 95% CI, 0.461-2.03). CONCLUSIONS: Based on a case-control study, infection with H pylori, particularly the cagA+ strain, is associated inversely with Barrett's esophagus. We observed a trend toward an inverse association with esophagitis, but not with GERD symptoms. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/23988686/Association_between_Helicobacter_pylori_and_Barrett's_esophagus_erosive_esophagitis_and_gastroesophageal_reflux_symptoms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(13)01231-7 DB - PRIME DP - Unbound Medicine ER -