Abstract
Eradication of <i>H. pylori</i>has been reported to improve gastric atrophy and induce reflux esophagitis in some peptic ulcer patients. Purpose:To investigate the effect of eradication on acid secretion and acid gastro-esophageal reflux (GER) by 24 h monitoring of pH in the esophagus and stomach and by gastric juice examination before and after treatment, simultaneously. Methods: Sixteen <i>H. pylori</i>-positive gastric ulcer patients (11 males; mean age: 52.9±3.3 y.o.) were treated with 2-week-long dual therapy (omeprazole 40 mg + amoxycillin 1500 mg/day) after patient's informed consent. Eradication was defined by negative for culture and <sup>13</sup>C urea breath test >4 weeks after ending the treatment. The two-channel pH probe equipped with pH monitor system (Digitrapper MK III; Synestics Medical) was inserted under the fluoroscope and one electrode was located on the esophageal lumen 5 cm orally from the E-C junction and another on the gastric corpus. Gastric juice test for acid secretion was performed after overnight fasting according to the standard protocol. pH monitoring and gastric acid secretion test were performed under hospitalization 72 h after stopping the drug(s) affecting gastric acidity. Borderline of atrophy and histology (inflammation, atrophy) of the antrum and corpus were evaluated by endoscopic finding and Sydney system, respectively. Results: 1) Eradication was succeeded in 12 patients. 2) Gastric mean pH, gastric pH>3 holding time ratio (pH3-HTR), and grade of endoscopic atrophy and histological inflammation were higher in eradicated group than those in persistent infection. 3) Nocturnal intragastric pH inversion (NIPI) phenomenon was observed in 10 among 12 eradicated cases. Endoscopic atrophy and active gastritis were more remarkable in NIPI. NIPI disappeared after success in eradication. 4) An improvement of gastritis, a decrease in gastric mean pH, pH3-HTR, and an increase in basal acid output and maximal acid output were demonstrated in patients with success in eradication. 5) GER after eradication was observed in 6 cases. Gastric mean pH and pH3-HTR were lower and an improvement of antral neutrophil infiltration was more apparent in GER-positive eradicated patients compared with GER-negarive ones. Conclusions: These results suggest that NIPI may reflect severe gastric atrophy accompanied by corpus neutrophil infiltration and that <i>H. pylori</i>eradication results in recovery of antral gastritis and gastric acid secretion, enhancing the potency of GER in gastric ulcer patients.
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