Low Rate of Symptomatic GERD Found After Successful H Pylori Eradication

h pylori, helicobacter pylori bacteria
Investigators assessed clinical predictors and the timing associated with development of symptomatic gastroesophageal reflux disease following H pylori infection eradication.

About 12% of patients who have had successful eradication of Helicobactor pylori (H pylori) infection develop symptomatic gastroesophageal reflux disease (GERD), researchers reported in the Scandinavian Journal of Gastroenterology.

A total of 330 patients with H pylori infection who were treated with a standard triple-drug regimen at a center in Japan from April 2014 to October 2020 were enrolled in the study. Primary regimens that were used included amoxicillin, clarithromycin, and a proton pump inhibitor (PPI)/vonoprazan twice daily for 1 week.

Participants had a mean age of 55.5±0.8 years, and 53% were women. The first-line eradication had a success rate of 89%, and the vonoprazan-based regimen had a higher success rate vs PPI-based regimens.

After a mean follow-up of 2.8 years, 41 (12%) patients developed symptomatic GERD requiring PPI/vonoprazan therapy. The rates of being free of GERD symptoms at 6 months, 1 year, and 2 years after eradication were 97%, 93%, and 89%, respectively.

The study authors also analyzed predictors for developing symptomatic GERD requiring PPI/vonoprazan therapy. Multivariate analysis showed that the rates of being free of GERD symptoms at 1 year were 84% and 95% in patients with and without a current smoking habit (P =.037, log-rank test), 63% and 94% in patients with and without functional dyspepsia (P <.001), 71% and 94% in patients with and without a hiatal hernia (P <.001), and 90% and 99% in patients with and without severe gastric atrophy, respectively (P =.012).

Data for 20 patients from before treatment and 1 month after treatment for symptomatic GERD were available, and all were treated with vonoprazan. Mean scores in the GERD domain on the Izumo scale for this group significantly decreased 1 month after vonoprazan treatment.

The researchers noted several limitations to their findings, including the retrospective, observational design. Additionally, reflux esophagitis was not evaluated periodically with esophagogastroduodenoscopy after eradication therapy, and the effect of vonoprazan on the development of GERD symptoms was not evaluated using the Izumo scale in all patients.

“[T]he rate of developing symptomatic GERD requiring PPI/[vonoprazan] therapy after H. pylori eradication success is low after long-term follow-up, and can be easily controlled using [vonoprazan] therapy,” stated the investigators. “However, patients who are current smokers, have functional dyspepsia, hiatal hernia, or severe gastric atrophy should be followed carefully after eradication. Considering the balance between the benefits of eradication therapy and the risk of GERD, physicians should not hesitate to treat patients with H. pylori infections,” they concluded.

Disclosure: Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.


Shinozaki S, Osawa H, Hayashi Y, et al. Predictors and timing for the development of symptomatic gastroesophageal reflux disease after successful Helicobactor pylori eradication therapy. Scand J Gastroenterol. Published online September 21, 2021. doi: 10.1080/00365521.2021.1975310