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. 2001 Sep;49(3):335–340. doi: 10.1136/gut.49.3.335

Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oesophagitis compared with gastric cancer: analysis of 5732 Japanese subjects

Y Yamaji 1, T Mitsushima 1, H Ikuma 1, M Okamoto 1, H Yoshida 1, T Kawabe 1, Y Shiratori 1, K Saito 1, K Yokouchi 1, M Omata 1
PMCID: PMC1728449  PMID: 11511553

Abstract

BACKGROUND—The relationship between Helicobacter pylori and reflux oesophagitis remains controversial.
AIMS—To evaluate the relationship between H pylori and reflux oesophagitis in a large number of Japanese subjects.
SUBJECTS—A total of 5732 consecutive Japanese subjects during a health screening were enrolled.
METHODS—Gastrointestinal endoscopy was performed on all subjects. We simultaneously measured serum anti-H pylori antibody and pepsinogen as markers of H pylori infection together with gastric atrophy. The risk of reflux oesophagitis was evaluated in relation to these markers, and the results were compared with those of gastric cancer.
RESULTS—Reflux oesophagitis was found in 108 subjects. Both positivity for H pylori antibody (adjusted odds ratio (OR) 0.67 (95% confidence interval 0.45-1.0)) and "low" pepsinogen indicating gastric atrophy (OR 0.35 (0.18-0.68)) were negatively associated with reflux oesophagitis. After subjects were classified into four groups based on positivity or negativity for H pylori antibody and "low" pepsinogen, the prevalence of reflux oesophagitis showed a decreasing trend as H pylori induced gastric atrophy became more severe. The risk of gastric cancer showed an increasing trend, exactly the opposite to that of reflux oesophagitis.
CONCLUSIONS—Analysis of a large series of Japanese subjects revealed a decreasing prevalence of reflux oesophagitis in conjunction with progress of gastric atrophy induced by H pylori infection. This pattern was completely opposite to that of gastric cancer cases. A protective role of H pylori for reflux oesophagitis through the development of gastric atrophy has been suggested.


Keywords: Helicobacter pylori; oesophagitis; gastro-oesophageal reflux disease; atrophic gastritis; gastric cancer

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Figure 1  .

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Prevalence of reflux oesophagitis in all subjects in each group, categorised by serum Helicobacter pylori antibody (HpAb) and pepsinogen level (PG), showed a gradually decreasing trend in the order of group A to group D (A), the exact opposite to the pattern presented by the increasing trend of gastric cancer (B). The odds ratios with 95% confidence intervals (OR (95% CI)) between adjacent groups, which may reflect the progress of gastric atrophy induced by H pylori infection, adjusted for sex and age using unconditional logistic regression models, were 0.58 (0.44-0.76; p<0.0001) for reflux oesophagitis and 2.3 (1.5-3.4; p<0.0001) for gastric cancer.

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