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Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease - Gastroesophageal Reflux...

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Unformatted text preview: Gastroesophageal Reflux Disease and Helicobacter pylori Helicobacter pylori Infection Infection By Salim A. Itani M.D. Beirut-Lebanon Helicobacter Pylori Helicobacter The discovery of H. pylori in H. gastric mucosa has changed the understanding and management of several gastroduodenal diseases. diseases H.Pylori H.Pylori Benefits of the eradication of H. pylori Benefits eradication have been reported from patients :presenting presenting .Peptic ulcer disease Peptic * Mucosa associated lymphoid tissue Mucosa . (MALT) lymphoma (MALT) .Gastric adenocarcinoma * Gastric * H.Pylori &GERD H.Pylori However the improvement of However symptoms in patients with GERD after the eradication of GERD the bacteria remains bacteria controversial . controversial Questions Questions 1- Is there any association between association GERD and H.Pylori infection ? GERD 2-What is the reflection of presence of What presence H.Pylori infection on GERD ? H.Pylori 3-What is the reflection of eradication What eradication of H.pylori on GERD ? of H.pylori and GERD ?a confusing issue confusing Several studies showed a number Several of controversies . controversies The role of H. pylori infection in The GERD remains controversial. controversial controversy controversy The controversy is important because GERD and its complications appear to be GERD increasing , whereas H.Pylori is increasing H.Pylori decreasing . decreasing Evidence for an association Evidence Clinical Studies : -mostly retrospective and not designed to address -mostly retrospective this relationship; this -did not have effect of eradication on GERD as a -did primary outcome measure. primary -variable results in .GERD .Esophagitis .Esophagitis .Barrett’s .Barrett’s No convincing evidence to indicate: … a causal relationship between GERD and relationship H.pylori. H.pylori. …that this organism has a significant that deleterious effect on any of the major deleterious pathophysiological factors in GERD. pathophysiological STUDY STUDY In a prospective ,double blind study , In (*)demonstrates ,using excellent GERD quantifying measures including validated symptom severity scores, endoscopy, and24hrs symptom PHmetry,that there exist NO clinically significant PHmetry,that differences in clinical or laboratory related GERD manifestations between H.Pylori infected and non infected GERD patients. non (*)Fallone et al (Aliment.Pharma. Therapy, 20(7) (761-768 ),2004) Hypothesis Hypothesis The previous hypothesis that H. pylori The infection protects from the development of protects GERD is thought to be an erroneous erroneous concept recently. concept Factors that influence the outcome of studies of this relationship of Prevalence of GERD and H.pylori, H.pylori The pathological severity of GERD at the severity time of presentation and investigation, time The coexistence of peptic ulceration , The peptic And the pathogenicity of the organism. And pathogenicity Chronic antrum –predominant Chronic antrum gastritis gastritis Hypergastrinemia and increased secretion of acid leads to gastritis and Duodenal ulcer ulcer In the presence of GERD ,reflux In esophagitis becomes more common . esophagitis By treating the D.U. and eradicating By H.pylori, The acid load in stomach will .pylori, acid decrease to Normal without a change in the parietal cell sensitivity to gastrin. the Corpus predominant gastritis Corpus predominant Inverse relationship between the prevalence H.pylori ,and that of Barrett’s H.pylori Barrett’s esophagus and its complications. esophagus Corpus predominant gastritis, esp. those Corpus who are cagA positive leads to gastric cagA atrophy and hypochlorhydria,thus reducing the esophageal acid load and esophagitis. esophagitis. +CagA CagA The presence of the CagA+ gene in The CagA+ H.pylori has been implicated as a marker of more severe histological gastritis, severe CagA+ association with GERD has been CagA+ evaluated in several studies with conflicting results. conflicting +CagA CagA There is no evidence that infection with There no cagA+ strains of H. pylori reduces risk of cagA+ reduces Esophageal & gastric cardia Esophageal adenocarcinoma. adenocarcinoma. +CagA CagA Studies confirm the positive association Studies positive between risk of distal gastric cancer and distal gastric infection with H.pylori infection , esp. CagA+ H.pylori CagA+ Strains. Strains. Corpus- predominating gastritis CorpusEradication therapy of H.pylori will lead to Eradication normal acid secretion. normal For GERD patients, there in no evidence For GERD no that eradication exacerbates GERD eradication symptomatology or pathology. symptomatology In any event , any exacerbation In (esophagitis) will be minor and can be will dealt with by PPI therapy. dealt Recommendations Recommendations It has been recommended to eradicate It eradicate H.pylori infection in those patients with GERD needing long term treatment with GERD PPIs, as some studies have reported that PPIs as these drugs induce , in presence of the drugs organism, atrophic gastritis with the atrophic consequent risk of gastric cancer. gastric Eradication Therapy Eradication When H.pylori eradication is When Indicated in a particular patient, the concomitant diagnosis of GERD should not change our GERD should attitude. attitude. Take Home Message Take There is, indeed, evidence to There indicate that eradication of H. eradication Pylori benefits the GERD benefits patient. patient. THANK YOU THANK ...
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