Prevalence of histological reflux oesophagitis in H. pylori positive patients: effect of density of H. pylori and activity of inflammation.

OBJECTIVE Recently there has been a great interest in the role of Helicobacter pylori in gastroesophageal reflux disease. Many studies do not show any significant difference in the overall prevalence of H. pylori in patients with endoscopic oesophagitis and controls. In this prospective study we assessed the influence of H. pylori density and activity of inflammation in different parts of stomach on histological oesophagitis. METHODS One Hundred and forty consecutive patients undergoing endoscopy for dyspepsia and heartburn were evaluated. Three biopsies were taken from antrum and two each from corpus, cardia and lower oesophagus. Urease test (CLO test) was performed. Density and activity of infection was assessed in a semi-quantitative way. RESULTS One Hundred and Fourteen (81%) patients from the 140 endoscoped, were positive for H. pylori and had H. pylori positive antral gastritis. Of these 114 cases, H. pylori were detectable in 104 (91%) of biopsies taken from corpus and 96 (84%) of biopsies from cardia. There was a strong correlation of density of H. pylori (0-3) in antrum with body and of body with cardia by Spearman correlation tests (p = 0.000). But H. pylori were more dense in antrum as compared to corpus and in corpus as compared to cardia (p = 0.0000 and 0.0003 respectively by Wilcoxon's rank test). Neutrophil activity and degree of mononuclear infiltrate were also greater in antrum as compared to corpus (p = 0.000 and 0.059). The activity and degree of inflammation was not significantly different in corpus-cardia pair. Out of 114 H. pylori positive patients, 75 had histological oesophogitis (p = 0.855). After excluding cases of hiatal hernia (H.H) and gapping lower oesophageal sphincter (LOS), number of H. pylori positive patients decreased to 73, out of these 50 had histological oesophagitis (p = 0.103). In all H. pylori positive patients with histological oesophagitis, H. pylori density (1-3) in antrum correlated with severity of oesophagitis (P = 0.011). Neutrophil activity in antrum and corpus also correlated with the severity of histological oesophagitis (P = 0.024 and 0.035 respectively). Correlation further improved after excluding cases of HH and gapping LOS (P = 0.002 for H. pylori density and 0.026 and 0.004 for activity in antrum and corpus). No correlation could be found of density and activity of infection in cardia with histological oesophagitis. CONCLUSION Our H. pylori positive patients had more dense and severe infection in antrum. Those who had histological oesophagitis in addition showed a positive correlation of the density of H. pylori in antrum and neutrophil activity in antrum and corpus with the severity of histological oesophagitis.