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Am Fam Physician. 2004;70(4):765

Eradicating Helicobacter pylori has several drawbacks. Notably, there is the emergence of gastroesophageal reflux disease (GERD), the possibility of which has been supported by several clinical and epidemiologic studies, although contradicted by others. In this study, Levine and colleagues evaluated the effect of H. pylori eradication on GERD symptoms and epigastric pain in children and adolescents.

Children eight to 19 years of age who were referred for gastroscopy because of upper abdominal pain, reflux symptoms, vomiting, hematemesis, and abdominal pain with weight loss were evaluated for H. pylori infection. Those who were found to be positive received eradication therapy. In follow-up, patients were evaluated for GERD symptoms. Patients with eradicated H. pylori were compared with two groups: those with H. pylori that was not eradicated, and those without H. pylori.

Ninety-five patients were followed for a mean of 11.2 months. Group 1 patients (N = 40) had no H. pylori; group 2 patients (N = 44) had successfully eradicated H. pylori; and group 3 patients (N = 11) had persistent H. pylori infection. One or more symptoms of GERD were present in 35 of the 95 patients at baseline, and these symptoms were not correlated with H. pylori infection. There was no significant difference in effect on reflux between groups. Reflux worsened in 12 percent, 18 percent, and 36 percent of groups 1, 2, and 3, respectively, and improved in 30 percent, 34 percent, and 36 percent, respectively. Overall, more patients improved than deteriorated. Improvement of pain did not correlate with H. pylori eradication. All three groups demonstrated a significant improvement in frequency and severity of epigastric pain at the final follow-up compared with baseline. Improvement in epigastric pain was significantly correlated with improvement in reflux symptoms.

The change in GERD symptoms in these children was not worse than the initial baseline symptoms with H. pylori eradication compared with no H. pylori eradication, or in patients who did not have H. pylori infection. H. pylori eradication does not seem to aggravate GERD. Increases in GERD symptoms in adults with H. pylori eradication suggest that GERD has a different patho-physiology in adults than it has in children. Of note, improvement in reflux symptoms was a strong predictor of improvement in epigastric pain.

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