Impact of Helicobacter pylori Status on GERD, Barrett’s Esophagus and Esophageal Cancer

Abstract

Helicobacter pylori (H. pylori) is an exceptionally common human pathogen infecting a large proportion of the world’s population. It is known to cause gastritis, peptic ulcer disease, non- cardiac gastric adenocarcinoma, and gastric mucosa-assisted lymphoid tissue lymphoma. Test and treat is a widely practiced strategy for H. pylori infection worldwide. While there are clear benefits of treating H. pylori infection, long-term adverse consequences of widespread eradication of this commonly identified pathogen remain an area of much debate. H. pylori infection affects gastric acid secretion and the relationships of the infection with gastroesophageal reflux disease (GERD), Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) have been studied but remain controversial topics. Review of the most up-to-date evidence from studies performed in the last 20 years suggests a possible inverse relationship between the prevalence of H. pylori infection and GERD. A meta-analysis of a randomized controlled trial showed that eradication of the infection was more likely to cause increased incidence of GERD. Additionally, other studies have noted a significant protective effect of H. pylori infection, notably Cag A+ strains, against the development of BE and EAC. In this review article, we will discuss the impact of H. pylori infection status on GERD, BE, and esophageal cancer.