H. pylori and GERD- Are they related?

Have you ever wondered if H. pylori and GERD are related?

There are a number of increasing studies suggesting a connection between GERD and H. pylori and I wanted to dig into the research to see what it has to say.  

Before we get into the research, let’s review what pangastritis, corpus-dominant gastritis, and antral-dominant gastritis are, as they will be helpful in understanding the results of a peer-review article that I will be referencing.

• Pangastritis: inflammation of the entire stomach wall
• Corpus-dominant gastritis: inflammation of the main portion of the stomach lining
• Antral-dominant gastritis: inflammation in the stomach lining found in the lower portion of the stomach

Now, for the research.

I looked at a peer-reviewed paper by Pandolfinio et al., which discusses H. pylori and GERD. They concluded that H. pylori eradication does not cause GERD, it only exposes it.

It is thought that because people with GERD have preserved acid secretion, it is likely that these people have either antrum-dominant or mild corpus-dominant gastritis. Pandolfinio et al. concluded that eradication of H. pylori should not worsen acid reflux greatly in those people with previous GERD and should improve reflux in people with antrum-dominant gastritis.

Some reports have found that people with H. pylori were less likely to have GERD and for those people with esophagitis, the degree of esophagitis was reduced compared to those who did not have H. pylori. Also, some data suggest that H. pylori, particularly Cag A strains, may be protective against the more severe forms of GERD.

Although this may seem good, Cag A strains of H. pylori are also associated with stomach cancer.

What kind of effect does H. pylori have on PPI therapy for those people who take PPIs to manage their reflux already?

It can be assumed that H. pylori increase the acid-suppressive effect of PPIs. Research states that just because H. pylori increases the acid-suppressive effects of PPIs, there is no need to change the dose required to keep the remission of esophagitis.

One review of GERD found possible protection against GERD by more virulent strains of H. pylori. Another study done by Alakkari et al. presumes that GERD might be more common/severe in people without H. pylori. Their research looked at several different factors such as different H. pylori phenotypes, weight gain after H. pylori eradication and effects on hormones that control appetite.

The thinking from Alakkari et al. is that weight gain may be worse in those people without H. pylori stemming from two different assumptions. First, they suggest that weight gain after H. pylori eradication can be attributed to feeling better and having fewer symptoms of reflux/heartburn. Second, H. pylori may have negative effects on circulating ghrelin levels, which is designed to help the body regulate food intake and energy homeostasis, which can stimulate the appetite and lead to weight gain.

Overall, more research is needed since the association between GERD and H. pylori is a very complex topic. 

1. _{Zanin, T. (2022, March 1). Pangastritis: What is it, symptoms and treatment. Tua Saúde. Retrieved November 29, 2022.}
2. _{Doctors, A. (2022, October 20). What is antral gastritis? - treatments and symptoms. Apollo Hospitals Blog. Retrieved November 29, 2022.}
3. _{Pandolfino, J.E., & Kahrilas, P.J. (n.d.). Helicobacter pylori and gastroesophageal reflux disease. UpToDate. Retrieved November 29, 2022.}
4. _{Isakov, V., & Malfertheiner, P. (2003). Helicobacter pylori and nonmalignant diseases. Helicobacter, 8 Suppl 1, 36–43.}