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BMJ. Aug 14, 2004; 329(7462): 402.
PMCID: PMC509386

Helicobacter pylori and gastro-oesophageal reflux disease

Important data were not presented
Ian L P Beales, senior lecturer

Editor—The paper by Harvey at al shows several inconsistencies.1 The first line contains an error: most patients with Helicobacter pylori actually have a mild pangastritis with normal or decreased intragastric acidity; the antral inflammation stimulates hypergastrinaemia but is balanced by a relative suppression of acid secretion by the oxyntic body, and duodenal ulcer occurs in only 10% of infected patients.2

The authors seem confused as to whether they are assessing gastrooesophageal reflux disease, as claimed, or occasional symptoms. The prevalence of symptoms once a month, the authors' definition, is very high and may not be pathological. Authorities propose that heartburn twice a week is a more reasonable definition of reflux disease.3

If the study was designed to address the question of H pylori and reflux the structure is suboptimal. Well validated questionnaires designed specifically for reflux symptoms are available.4 Reflux is more severe in elderly people,4,5 and by excluding people over 60 Harvey et al may not have studied those most at risk. The authors used a questionnaire, but there is no evidence that this has been validated against reliable measures of gastro-oesophageal reflux disease such as endoscopic Los Angeles scoring or ambulatory oesophageal pH monitoring. All these issues are important when comparing this paper with the others cited that have used much more objective diagnoses of the disease.

Harvey et al discuss the pathophysiology of the infection, but the important data relating H pylori clearance, as opposed to intending eradication, to reflux have not been presented.


Competing interests: None declared.


1. Harvey RF, Lane JA, Murray LJ, Harvey IM, Donovan JL, Nair P. Randomised controlled trial of effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project. BMJ 2004;328: 1417-9. [PMC free article] [PubMed]
2. Beales I. The H. pylori-gastrin link. In: Merchant JL, Buchan AM, Wang TC, eds. Gastrin in the new millennium. Los Angeles: CURE Foundation, 2004: 253-63.
3. Dent J, Brun J, Fendrick AM., Fennerty MB, Janssens J, Kahrilas PJ, et al. An evidence-based appraisal of reflux disease management—the Genval workshop report. Gut 1999;44: S1-S16. [PMC free article] [PubMed]
4. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR, Rodriguez-Artalejo F. Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther 2004;19: 95-105. [PubMed]
5. Collen MJ, Abdulian JD, Chen YR. Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy. Am J Gastroenterol 1995;90: 1053-7. [PubMed]

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