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a Division of
Gastroenterology, Department of Internal Medicine, University of Tokyo,
Tokyo, Japan, b Department of Gastroenterology, Kameda General
Hospital, Kamogawa, Japan, c Makuhari Clinic, Chiba, Japan
Correspondence to: Dr Y Yamaji, Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. yamaji-tky{at}umin.ac.jp
Accepted for publication 23 January 2001
BACKGROUND
The
relationship between Helicobacter pylori and
reflux oesophagitis remains controversial.
AIMSTo evaluate the
relationship between H pylori and reflux
oesophagitis in a large number of Japanese subjects.
SUBJECTSA total of
5732 consecutive Japanese subjects during a health screening were enrolled.
METHODSGastrointestinal
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.
RESULTSReflux
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.
CONCLUSIONSAnalysis
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.
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