RESUMO
METHODS: Prospective post-eradication evaluations were conducted in 331 H. pylori positive patients with peptic ulcer diseases who were confirmed not to have GERD before eradication therapy. Endoscopic findings of reflux esophagitis were according to the Los Angeles classification system. Patients were categorized in the nonerosive reflux disease (NERD) subgroup by results of 24-hour ambulatory pH-metry (reflux episodes, pathological oesophageal acid exposure, DeMeester score > 14.7). After that all patients received H. pylori eradication therapy. After eradication therapy, during follow-up for up to 5.0 years, endoscopies, 24-hour ambulatory pH-metries were performed on patients with occasions of acid regurgitation or heartburn. RESULTS: GERD developed in 79 of 280 (28%) patients cured of infection and in 6 of 51 (11.8%) patients who had persistent infection (p < 0.013, Pearson's test). The risk of developing GERD in patients cured of infection was still significantly higher than in the patients who had persistent infection (p < 0.036, log-rank test; Kaplan-Meier analysis). NERD and mild esophagitis were in mostly patients. Multivariate analysis with the Cox's Proportional-Hazards Regression identified cure of infection (hazard ratio, 2.294, 95% confidence interval, 1.043-5.494, p = 0.039), hiatal hernia (1.828, 1.177-2.838, p = 0.007), high body mass index (1,084, 1.019-1.152, p = 0.01), male gender (0.139, 0.034-0.567, p = 0.006) as significant factors for the risk of developing of gastroesophageal reflux disease. CONCLUSION: Eradication of H. pylori infection may increase the risk of developing reflux esophagitis in patients with peptic ulcer who were confirmed not to have GERD before eradication therapy. Hiatal hernia, high body mass index, male gender may be serve as additional risk factors.
