Can GERD be caused by H. pylori bacteria?

M.

Helicobacter pylori (H. pylori) is a type of bacterium commonly found in the stomach. Although it was only identified about 15 years ago, it has been with us for thousands of years. Much research into the association between this bacterium and various digestive diseases has been performed. A breakthrough in the treatment of ulcer disease came with the discovery that H. pylori is involved in the vast majority of both stomach and duodenal ulcers. After the connection with H. pylori was found, a new three-drug regimen designed to eradicate the infection has lowered the ulcer recurrence rate to almost zero.

H. pylori has also been linked to the development of stomach cancer and lymphoma, both relatively rare disorders. Further research has focused on the relationship between H. pylori and the more common diseases of GERD (gastroesophageal reflux disease) and dyspepsia (upper abdominal pain not associated with ulcers). Several studies have shown that eradication of H. pylori does not lead to improvement in dyspepsia symptoms.

However, an interesting relationship was found between H. pylori and GERD. In many early studies looking into ulcer disease and H. pylori, investigators noted that ulcer patients often complained that their GERD symptoms grew worse after successful treatment of their H. pylori infection. Initially, researchers were puzzled as to why this would occur. Additional studies then showed that in patients with H. pylori, acid-suppressing medications are extremely effective. This is true because H. pylori bacteria interfere with the ability of the stomach to produce the normal amount of acid. These studies showed that after the H. pylori was eradicated, the acid-suppressive medications were not as effective. Thus, the cure of the H. pylori infection led to a recovery of the stomach's ability to make acid. Since GERD is a disease in which stomach acid irritates the esophagus, it is not surprising that these patients had a worsening of their GERD after H. pylori was eradicated.

Many doctors who are treating H. pylori in ulcer patients who also have GERD now tell them that their GERD may worsen, and that they may have to take additional or higher doses of their GERD medications. Some experts have also questioned the need to treat all cases of H. pylori infection. But for now, the recommendation is still to treat all people infected with H. pylori because of the benefit of preventing ulcers and gastric cancer.