helicobacter pylori ( h. pylori ) is a type of bacterium that frequently colonizes the lining of the stomach .
h. pylori infection is recognized to be the most important acquired factor in the etiology of ulcers of the stomach and duodenum .
h. pylori infection was also shown to be associated with active gastritis , gastric carcinoma and gastric mucosal associated lymphatic tissue ( malt ) lymphoma .
it is believed that eradication therapy is a powerful way to cure h. pylori - related diseases .
but the relationship between h. pylori and gastroesophageal reflux disease ( gerd ) is still unclear , and the effect of h. pylori eradication on gerd treatment is unknown . in this study , we selected patients with reflux esophagitis to explore the effect of h. pylori and its eradication on reflux esophagitis treatment .
patients from digestive disease center of peking university third hospital , wu han union hospital , shanghai changhai hospital , and the first affiliated hospital , sun yat - sen university were enrolled between january 2007 and october 2010 . included criteria were : almost 1870 years of age , typical reflux symptoms ( heartburn , acid regurgitation and chest pain ) , and diagnosis of reflux esophagitis ( los angeles [ la ] a - d degree ) .
the la classification was used for the patients with reflux esophagitis , and those with reflux esophagitis la - a to la - d were all enrolled .
patients were excluded with : peptic ulcer , carcinoma of upper gastrointestinal tract , esophageal varices , zollinger  ellison syndrome , esophageal stricture , barrett 's esophagus , other severe gastrointestinal disease ( for example ulcerative colitis ) , and accompanying severe diseases of other systems .
pregnant or lactating females , and patients who had undergone proton pump inhibitor ( ppi ) or bismuth therapy during the preceding 2 weeks were also excluded .
biopsy specimens for rapid urease test ( rut ) were obtained from biopsy forceps with a sterile needle and assessed immediately ; the results were examined by an experienced observer blinded to the clinical details .
the biopsy specimens for pathology were examined by an experienced pathologist after warthin  starry ( ws ) staining .
a sample was considered h. pylori positive with both rut and ws staining results positive .
h. pylori negative samples showed negative results in both tests . when discordant results were obtained for rut and ws , the patients were excluded from the study .
biopsy specimens were examined by ws staining , and samples were considered h. pylori positive with positive ws staining . before and after treatment , patients underwent gastroscopy and were examined by experienced doctors .
the severity of reflux symptoms was scored by the frequency and severity of the symptoms [ table 1 ] .
scores of frequency and severity of reflux symptoms we divided a day into three periods : from breakfast to lunch , lunch to supper and supper to breakfast .
if a reflux symptom appears in one , two or three periods , a score of one , two or three , was attributed , respectively .
h. pylori positive patients were first randomly divided into eradicated and uneradicated groups by random envelope . in the eradication group , patients underwent h. pylori eradication for 10 days , then received esomeprazole 20 mg bid for the following 46 days .
two eradiation regimens were randomly selected in this study : the eac regimen consisted of esomeprazole 20 mg bid , amoxicillin 1.0 bid and clarimothin 0.5 bid ; in the sequential regimen , esomeprazole 20 mg bid and amoxicillin 1.0 bid were administered for the first 5 days , while esomeprazole 20 mg bid , clarimothin 0.5 bid and tinidazole 0.5 bid were given for the following 5 days . in h. pylori positive uneradicated and h. pylori negative groups , patients were treated with esomeprazole 20 mg bid for 8 weeks .
afterward , all patients underwent gastroscopy again , and the ws staining test was repeated .
therefore , three groups were obtained : h. pylori positive eradicated , h. pylori positive uneradicated ( patients without h. pylori eradicated or unsuccessful eradication ) and h. pylori negative groups . for all patients ,
then , the healing rate of reflux esophagitis and remission of reflux symptoms were evaluated . 

 healed  was considered if there was no esophageal mucosal break after treatment ;  unhealed  indicated the presence of mucosal breaks . the healing rates among groups were comparedremission of reflux symptoms .
the main reflux symptoms , including acid regurgitation , heartburn , and chest pain were scored before and after treatment .
 healed  was considered if there was no esophageal mucosal break after treatment ;  unhealed  indicated the presence of mucosal breaks .
the main reflux symptoms , including acid regurgitation , heartburn , and chest pain were scored before and after treatment .
the  test and t - test were used , respectively , for enumeration and measurement data .
all statistical tests were two - sided , and a p < 0.05 was considered statistically significant .
patients from digestive disease center of peking university third hospital , wu han union hospital , shanghai changhai hospital , and the first affiliated hospital , sun yat - sen university were enrolled between january 2007 and october 2010 . included criteria were : almost 1870 years of age , typical reflux symptoms ( heartburn , acid regurgitation and chest pain ) , and diagnosis of reflux esophagitis ( los angeles [ la ] a - d degree ) .
the la classification was used for the patients with reflux esophagitis , and those with reflux esophagitis la - a to la - d were all enrolled .
patients were excluded with : peptic ulcer , carcinoma of upper gastrointestinal tract , esophageal varices , zollinger  ellison syndrome , esophageal stricture , barrett 's esophagus , other severe gastrointestinal disease ( for example ulcerative colitis ) , and accompanying severe diseases of other systems .
pregnant or lactating females , and patients who had undergone proton pump inhibitor ( ppi ) or bismuth therapy during the preceding 2 weeks were also excluded .
biopsy specimens for rapid urease test ( rut ) were obtained from biopsy forceps with a sterile needle and assessed immediately ; the results were examined by an experienced observer blinded to the clinical details .
the biopsy specimens for pathology were examined by an experienced pathologist after warthin  starry ( ws ) staining .
a sample was considered h. pylori positive with both rut and ws staining results positive .
h. pylori negative samples showed negative results in both tests . when discordant results were obtained for rut and ws , the patients were excluded from the study .
biopsy specimens were examined by ws staining , and samples were considered h. pylori positive with positive ws staining .
the severity of reflux symptoms was scored by the frequency and severity of the symptoms [ table 1 ] .
scores of frequency and severity of reflux symptoms we divided a day into three periods : from breakfast to lunch , lunch to supper and supper to breakfast .
if a reflux symptom appears in one , two or three periods , a score of one , two or three , was attributed , respectively .
h. pylori positive patients were first randomly divided into eradicated and uneradicated groups by random envelope . in the eradication group , patients underwent h. pylori eradication for 10 days , then received esomeprazole 20 mg bid for the following 46 days .
two eradiation regimens were randomly selected in this study : the eac regimen consisted of esomeprazole 20 mg bid , amoxicillin 1.0 bid and clarimothin 0.5 bid ; in the sequential regimen , esomeprazole 20 mg bid and amoxicillin 1.0 bid were administered for the first 5 days , while esomeprazole 20 mg bid , clarimothin 0.5 bid and tinidazole 0.5 bid were given for the following 5 days . in h. pylori positive uneradicated and h. pylori negative groups ,
afterward , all patients underwent gastroscopy again , and the ws staining test was repeated . therefore , three groups were obtained : h. pylori positive eradicated , h. pylori positive uneradicated ( patients without h. pylori eradicated or unsuccessful eradication ) and h. pylori negative groups .
then , the healing rate of reflux esophagitis and remission of reflux symptoms were evaluated . 

 healed  was considered if there was no esophageal mucosal break after treatment ;  unhealed  indicated the presence of mucosal breaks . the healing rates among groups were comparedremission of reflux symptoms .
the main reflux symptoms , including acid regurgitation , heartburn , and chest pain were scored before and after treatment .
 healed  was considered if there was no esophageal mucosal break after treatment ;  unhealed  indicated the presence of mucosal breaks .
the main reflux symptoms , including acid regurgitation , heartburn , and chest pain were scored before and after treatment .
the  test and t - test were used , respectively , for enumeration and measurement data .
all statistical tests were two - sided , and a p < 0.05 was considered statistically significant .
there were 176 patients infected with h. pylori and 180 patients without h. pylori . for h. pylori positive patients ,
ninety - two patients showed successful eradication , while the remaining 30 still had the bacteria , indicating an eradication rate of 75.4% .
therefore , there were 92 and 84 patients in the h. pylori positive eradicated and h. pylori positive uneradicated groups , respectively .
no significant difference in age , gender , height , and weight was obtained among groups [ table 2 ] .
general status of patients in different groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation . before treatment ,
reflux symptom scores in the h. pylori positive eradicated and h. pylori positive uneradicated groups were 8.04 and 7.13 , respectively ( p = 0.062 ) .
there was no statistically significant difference in the la degree between the two groups ( p = 0.307 ) [ table 3 ] .
esophagitis grade and symptom scores in the h. pylori positive groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation . after treatment ,
reflux symptom scores of 0.22 and 0.14 were obtained for the h. pylori positive eradicated and h. pylori positive uneradicated groups , respectively ( p = 0.588 ) .
the healing rate of reflux esophagitis were 80.4% and 79.8% , respectively , in the h. pylori positive eradicated and h. pylori positive uneradicated groups ( p = 0.911 ) [ table 4 ] .
healing rate and symptoms scores in the h. pylori positive groups after treatment h. pylori : helicobacter pylori ; sd : standard deviation . before treatment ,
reflux symptom scores in the h. pylori positive uneradicated and h. pylori negative groups were 7.13 and 7.18 , respectively ( p = 0.910 ) , and no statistically significant difference in la degree between the two groups was obtained ( p = 0.848 ) [ table 5 ] .
esophagitis grade and symptom scores in the h. pylori positive uneradicated and h. pylori negative groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation . after treatment , reflux symptom scores in the h. pylori positive uneradicated and h. pylori negative groups were 0.14 and 0.21 , respectively ( p = 0.546 ) . the healing rates of reflux esophagitis were 79.8% and 82.2% , respectively , in h. pylori positive uneradicated and h. pylori negative groups , respectively ( p = 0.632 ) [ table 6 ] .
healing rate and symptom scores in h. pylori positive uneradicated and h. pylori negative groups after treatment h. pylori : helicobacter pylori ; sd : standard deviation .
there were 176 patients infected with h. pylori and 180 patients without h. pylori . for h. pylori positive patients ,
ninety - two patients showed successful eradication , while the remaining 30 still had the bacteria , indicating an eradication rate of 75.4% .
therefore , there were 92 and 84 patients in the h. pylori positive eradicated and h. pylori positive uneradicated groups , respectively .
no significant difference in age , gender , height , and weight was obtained among groups [ table 2 ] .
general status of patients in different groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation .
before treatment , reflux symptom scores in the h. pylori positive eradicated and h. pylori positive uneradicated groups were 8.04 and 7.13 , respectively ( p = 0.062 ) .
there was no statistically significant difference in the la degree between the two groups ( p = 0.307 ) [ table 3 ] .
esophagitis grade and symptom scores in the h. pylori positive groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation . after treatment ,
reflux symptom scores of 0.22 and 0.14 were obtained for the h. pylori positive eradicated and h. pylori positive uneradicated groups , respectively ( p = 0.588 ) . the healing rate of reflux esophagitis were 80.4% and 79.8% , respectively , in the h. pylori positive eradicated and h. pylori positive uneradicated groups ( p = 0.911 ) [ table 4 ] .
healing rate and symptoms scores in the h. pylori positive groups after treatment h. pylori : helicobacter pylori ; sd : standard deviation .
before treatment , reflux symptom scores in the h. pylori positive uneradicated and h. pylori negative groups were 7.13 and 7.18 , respectively ( p = 0.910 ) , and no statistically significant difference in la degree between the two groups was obtained ( p = 0.848 ) [ table 5 ] .
esophagitis grade and symptom scores in the h. pylori positive uneradicated and h. pylori negative groups before treatment h. pylori : helicobacter pylori ; sd : standard deviation . after treatment ,
reflux symptom scores in the h. pylori positive uneradicated and h. pylori negative groups were 0.14 and 0.21 , respectively ( p = 0.546 ) .
the healing rates of reflux esophagitis were 79.8% and 82.2% , respectively , in h. pylori positive uneradicated and h. pylori negative groups , respectively ( p = 0.632 ) [ table 6 ] .
healing rate and symptom scores in h. pylori positive uneradicated and h. pylori negative groups after treatment h. pylori : helicobacter pylori ; sd : standard deviation .
h. pylori infection leads to chronic active gastritis with the potential for the subsequent development of peptic ulcer , malt lymphoma , and distal gastric cancer in some patients .
gerd is a common and costly disease in the community , with a negative impact on patients quality of life .
the major mechanisms associated with gerd include decreased pressure and increased frequency of spontaneous relaxation of the lower esophageal sphincter , with normal or increased secretion of gastric acid .
the relationship between h. pylori infection and gerd remains unclear , and the treatment of h. pylori in patients with gerd is highly controversial .
the prevalence of h. pylori infection has been steadily decreasing while gerd incidence is increasing in developed countries , suggesting a possible protective role of h. pylori infection in the development of gerd .
other evidences include the following : the infection rate of h. pylori in gerd patients is much lower than in the general population ; h. pylori is associated with the severity of gerd ; the infection rate of h. pylori in severe gerd patients is much lower than those with mild gerd .
indeed , the prevalence of h. pylori was shown to be similar between gerd and other patients , and h. pylori was not related to the severity of gerd . recently
, japanese studies suggested that after h. pylori eradication , gerd symptoms are relieved , and life quality improved .
the management of helicobacter pylori infection the maastricht iv / florence consensus report declares that h. pylori status has no effect on symptom severity , symptom recurrence and treatment efficacy in gerd .
in the chinese guideline for h. pylori treatment , it was indicated that gerd incidence may be increased in some eastern countries after h. pylori eradication .
therefore , the question remains as whether for gerd patients with h. pylori infection , h. pylori eradication is necessary or useful .
for the treatment of gerd , an agreement has been reached that ppi is the most important medicine . in the definition of montreal
however , in case of h. pylori infection combined with gastroesophageal reflux , h. pylori eradication therapy is needed , which is confusing to the clinicians ; this problem needs to be clarified as soon as possible . for most patients ,
but for different infection sites and types of gastritis , acid secretion may be decreased or increased after h. pylori infection .
based on this theory , some scientists have suggested that if acid secretion is increased by h. pylori infection , then the bacteria should be eradicated . on the other hand ,
so before h. pylori eradication , its effect on acid secretion should be first evaluated .
but it is difficult in clinical practice for doctors . in a study by calleja et al .
after 4 weeks treatment , the healing rate of reflux esophagitis was 86.6% in h. pylori positive patients .
after 8 weeks treatment , the healing rates in positive and negative groups were 96.4% and 91.8% , respectively .
the healing rates in the positive group were , therefore , higher than in the negative group , with significant differences . also , the rate of gerd symptom relief was higher in h. pylori positive patients compared with negative patients .
these findings suggested that based on the same treatment , a better outcome was obtained in h. pylori positive patients . in a prospective study by tefera et al .
after 15 months of h. pylori eradication , there was no significant difference between acid secretion and gerd symptoms . in a study by de boer et al .
, 1548 gerd patients underwent treatment with rabeprazole ; there was no significant difference between h. pylori positive and negative patients in rates of gerd symptom relief . from the above studies ,
a large - scale study to compare the treatment outcome between h. pylori positive and negative comprehensively is needed .
this was a multi - center , randomized , control , prospective study , with 356 patients enrolled .
based on the treatment of ppi , we explored the effect of h. pylori eradication on the treatment of reflux esophagitis .
we analyzed the effect of h. pylori infection first , and patients in h. pylori negative and h. pylori positive control groups were compared . after ppi treatment , no significant differences in healing rates of reflux esophagitis and the severity of reflux symptoms were obtained , indicating that h. pylori infection has no significant effect on the treatment of reflux esophagitis .
patients with h. pylori infection were enrolled , and h. pylori eradicated and h. pylori positive uneradicated groups were compared .
after the treatment with ppi , no significant difference was found in healing rates of reflux esophagitis and the severity of reflux symptoms .
it was concluded that h. pylori eradication has no significant effect on the treatment of reflux esophagitis .
although we found that h. pylori eradication itself has no significant effect on erosive esophagitis treatment , the asia - pacific consensus on h. pylori infection mentioned that long - term use of ppi therapy causes increased risk of gastric atrophy , which is a precancerous lesion . for patients with gerd , ppi is used for a long time , therefore , h. pylori therapy is recommended . in this study , patients were followed - up for only 8 weeks , and we plan to continue follow - up for years in order to determine the changes by h. pylori eradication therapy ; reflux esophagitis and relapse of reflux symptoms will be monitored , as well as gastric pathology .
 background : helicobacter pylori ( h. pylori ) frequently colonizes the stomach . gastroesophageal reflux disease ( gerd ) is a common and costly disease . but the relationship of h. pylori and gerd is still unclear . 
 this study aimed to explore the effect of h. pylori and its eradication on reflux esophagitis therapy.methods:patients diagnosed with reflux esophagitis by endoscopy were enrolled ; based on rapid urease test and warth  starry stain , they were divided into h. pylori positive and negative groups . 
 h. 
 pylori positive patients were randomly given h. pylori eradication treatment for 10 days , then esomeprazole 20 mg bid for 46 days . 
 the other patients received esomeprazole 20 mg bid therapy for 8 weeks . 
 after treatment , three patient groups were obtained : h. pylori positive eradicated , h. pylori positive uneradicated , and h. pylori negative . before and after therapy 
 , reflux symptoms were scored and compared . 
 healing rates were compared among groups . 
 the 2 test and t - test were used , respectively , for enumeration and measurement data.results:there were 176 h. pylori positive ( with 92 eradication cases ) and 180 negative cases . 
 healing rates in the h. pylori positive eradicated and h. pylori positive uneradicated groups reached 80.4% and 79.8% ( p = 0.911 ) , with reflux symptom scores of 0.22 and 0.14 ( p = 0.588 ) . 
 healing rates of esophagitis in the h. pylori positive uneradicated and h. pylori negative groups were , respectively , 79.8% and 82.2% ( p = 0.848 ) ; reflux symptom scores were 0.14 and 0.21 ( p = 0.546).conclusions : based on esomeprazole therapy , h. pylori infection and eradication have no significant effect on reflux esophagitis therapy . 