Could Ulcer Treatment Improve Acid-Reflux Symptoms?

Medically Reviewed by Gary D. Vogin, MD
4 min read

May 31, 2001 -- It's enough to give you a bellyache: A new study published in the June 2 issue of the journal The Lancet suggests that using antibiotics to eradicate ulcer-causing germs from the gut may also prolong relief from acid-reflux disease symptoms. Yet other researchers say that the bacteria may protect people against acid reflux. What gives?

The debate hinges around a bug known as Helicobacter pylori, or H. pylori. The bacteria have been fingered by researchers as the cause of about 80% of stomach ulcers and more than 90% of ulcers of the duodenum, the first segment of the small intestine. According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 1 in 5 people under 40 is infected with H. pylori, as are half of those over age 60.

Until recently, conventional wisdom held that stress and stomach acids were the primary cause of ulcers and that most bacteria couldn't thrive in the corrosive environment of the stomach. But dogged Australian physician Barry Marshall, MD, was convinced H. pylori can cause ulcers. He caught the world's attention and changed the way ulcers are treated when he deliberately guzzled down a megadose of the bacteria and developed an ulcer, which he then cured with a combination of antibiotics and Pepto-Bismol.

Some researchers also speculated that H. pylori might protect people against gastroesophageal reflux disease, or GERD -- the backup of stomach contents into the esophagus, the tube that connects the stomach to the throat. GERD can cause painful, recurrent heartburn and can damage the tissues lining the throat and esophagus.

The theory was that by damaging the stomach lining, H. pylori infection would also destroy the miniature pumps that release stomach acid, thereby cutting down on the likelihood of GERD.

But now comes the Lancet study, in which researchers found evidence to suggest that among patients with GERD, those who were infected with H. pylori but had the bacteria eliminated with antibiotics, as well as those who never had the infection to begin with, had a longer period free from GERD symptoms than did similar patients who still had H. pylori infections.

"Presence of H. pylori leads to a reduced disease-free interval, and, therefore, eradication therapy should be considered in patients with [GERD]," write Werner Schwizer, MD and colleagues.

In an interview with WebMD, Schwizer, associate professor of gastroenterology at University Hospital in Zurich, Switzerland, says that the theory about H. pylori being protective against GERD arose following an observation that some duodenal ulcer patients who received antibiotics to kill H. pylori infection later went on to develop Barrett's esophagitis, a disorder linked to acid-reflux disease. "There was indirect evidence, lets say observational evidence, without really testing that, so that was the basis of our study."

In the study 70 patients with GERD were divided into three groups, with all patients receiving the acid reducer Prevacid 30 mg twice daily for 10 days, followed by 30 mg once daily for 8 weeks. Patients who were infected with H. pylori were randomly assigned to receive either antibiotics or a placebo for the first 10 days. Patients not infected with H. pylori were used for comparison, which was called the control group.

The patients were followed for 6 months at 2-week intervals for GERD symptoms. At the end of the study, the researchers determined that patients who were still infected with H. pylori had on average an earlier return of symptoms (at 54 days) than patients in whom H. pylori had been eradicated (at 100 days). The control group had the longest symptom-free period, at 110 days.

When they classified the patients according to severity of inflammation of the esophagus, called esophagitis, those with the most inflammation relapsed rapidly, compared to those with low levels of inflammation. Once again, after the researchers considered the amount of esophagitis a patient had, the investigators found that those with H. pylori relapsed more rapidly.

The study was small, however -- only 58 patients completed the study, and the authors acknowledge that further research of the underlying mechanisms will be needed to confirm their observations.

A gastroenterologist who was not involved in the study tells WebMD that he's still not convinced.

"It's controversial, and even with this study, I'm unwilling to say that eliminating H.pylori will lead to improvement in GERD," says Ronnie Fass, MD, director of the gastrointestinal motility laboratory, and associate professor of medicine at the University of Arizona School of Medicine and Tucson VA Medical Center. "It has been shown that in patients with Barrett's esophagus, there is a lower likelihood of being infected with H. pylori, again suggesting a more protective effect for infection."