Some online articles and research studies have looked at a possible connection between Helicobacter pylori and gastro-oesophageal reflux disease (GERD).

It has been suggested that people with H. pylori are less likely to have GERD, whereas some people are concerned that H. pylori can lead to an increase in reflux symptoms.

Let’s take an at-a-glance review of what is certainly a complex subject.

What is H. pylori and how do we get it?

Helicobacter pylori (shortened to H. pylori) is a type of bacterium or germ which lives in the mucus lining of the stomach.

H. pylori is shaped like a corkscrew and is just three microns long – that’s about 0.003000000mm.

It is thought to spread through contaminated food and water, or through direct mouth-to-mouth contact.

H. pylori infections are common – the Centers for Disease Control and Prevention (CDC) estimates that approximately two-thirds of the world’s population harbours the bacterium.

In the UK only around 20 per cent of the population have H.pylori present and this often runs in families.

How do I know if I have H. pylori?

A ‘Helicobacter Pylori Breath Test’ is a simple way to determine whether or not you have an infection. A patient breathes down a straw into two tubes before drinking 200ml of water containing a sachet with a mixture of citric, tartaric and malic acid.

The patient drinks 50ml of water containing Urea. After a 30-minute wait, patients breathe down a straw into two more tubes.

There are also Helicobacter pylori stool tests, blood tests and endoscopy/biopsy tests.

What problems can H. pylori cause?

Many people with it in their stomach don’t have any signs or symptoms.

However, in some people, the bacteria can irritate the stomach lining and make it more vulnerable to damage from the stomach acid.

– Peptic ulcers

H. pylori are strongly associated with causing peptic ulcers – sensitive patches in the lining of the gastric epithelium. The bacteria damage the mucus coating that protects the lining of the stomach and duodenum, allowing stomach acid and pepsin to cause irritation and damage.

A study in Digestive and Liver Disease found that around 60 to almost 100 per cent of peptic ulcers are associated with H. pylori.

In patients who do present with peptic ulcer and or gastritis, ‘Triple Therapy’ is often used to eliminate the H.pylori infection and this consists of a minimum of seven days treatment with a combination of a PPI, an antibiotic and bismuth.

– Gastritis

An H. pylori infection can sometimes cause recurring bouts of indigestion and gastritis, as the bacteria can cause inflammation of the stomach lining.

So, what is the connection with reflux disease?

Many studies have shown that H. pylori does not cause GERD itself and that treatment for the bacteria does not reduce symptoms of reflux disease.

The consensus appears to be that H. pylori should not be treated with the intent to either improve reflux symptoms or prevent the development of reflux complications.

However, experts have proposed the hypothesis that declining infection rates of H. pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.  There have been many studies since looking at why this is the case, with no clear conclusion to date.

Some researchers suggested that H. pylori and GERD seem to have, in any case, a ‘friendly’ relationship, although it may be transformed into one of ‘hate’ when proton pump inhibitors (PPIs) enter the scene.

A 2001 Korean study suggested that H. pylori may have a protective role against gastroesophageal reflux disease.

Conclusion:

The association between H. pylori infection and gastro-oesophageal reflux disease remains somewhat controversial although the general consensus it that if an individual has H.pylori infection and no peptic ulcer or gastritis it should not be eliminated as there is good clinical evidence that in cases where it has been eliminated the individual is more susceptible to developing reflux disease (GERD).