Abstract
The association between gastroesophageal reflux disease (GERD) prevalence and its risk factors in an area with low Helicobacter pylori prevalence is important to clarify. We analyzed the prevalence of GERD and risk factors in an area of Indonesia with low prevalence of H. pylori infection. We recruited 104 dyspeptic patients who underwent endoscopy in Surabaya. Patients were diagnosed with GERD based on the Los Angeles classification. We evaluated gastric biopsy specimens and measured serum pepsinogen levels. Interleukin polymorphisms were evaluated by polymerase chain reaction-restriction fragment length polymorphism. Of 104 patients, 56 (53.8%) were endoscopically found to have GERD, with most categorized as grade A; 48 (46.2%) were classified as non-GERD. Higher economic status, smoking, and a history of proton-pump inhibitor use significantly increased the risk of GERD. GERD Questionnaire scores showed a positive correlation with GERD (P < 0.001). An association was found between antral atrophic gastritis and GERD (P = 0.030), and patients with GERD more frequently had severe antral atrophy than nonerosive reflux disease (P = 0.018). We found an association between pepsinogen I/II levels and GERD (P = 0.047), but with low accuracy. IL-1β -511 TT and CT were predominant among the IL-1β -511 genotypes, and IL-8–251 AT and TT were predominant among the IL-8–251 genotypes. In conclusion, we found a high prevalence of GERD in an area with low prevalence of H. pylori infection, which could be associated with acid reflux. Smoking, history of proton-pump inhibitor use, and higher economic group significantly increased the risk of GERD.
Highlights
Helicobacter pylori infection, the most prevalent human chronic bacterial infection [1], modifies gastric acid secretion, affecting gastroduodenal disease pathogenesis, including gastroesophageal reflux disease (GERD) [2], GERD is a condition wherein gastric reflux or complications expose the gastric contents to the esophageal squamous epithelium [3].The hypothesis regarding an H. pylori–GERD association has been reinforced by the parallel of increasing GERD incidence with decreasing H. pylori infection prevalence in Asia [4, 5]
Smoking was shown to be an important factor in GERD development, given that more than three-quarters of the patients with a history of smoking cigarettes had GERD (19/25; 76.0%) and onethird of the patients with GERD had a history of smoking (19/56; 33.9%)
Statistical analyses showed that the smokers had a significantly higher risk of developing GERD compared with nonsmokers (OR = 3.60, P = 0.014)
Summary
Helicobacter pylori infection, the most prevalent human chronic bacterial infection [1], modifies gastric acid secretion, affecting gastroduodenal disease pathogenesis, including gastroesophageal reflux disease (GERD) [2], GERD is a condition wherein gastric reflux or complications expose the gastric contents to the esophageal squamous epithelium [3]. The hypothesis regarding an H. pylori–GERD association has been reinforced by the parallel of increasing GERD incidence with decreasing H. pylori infection prevalence in Asia [4, 5]. Some authors consider GERD as an acid reflux-related disease and H. pylori as a biological secretory or anti-secretory agent [6, 7]. Acid secretion in corpus predominant gastritis decreases, inhibiting severe reflux development, contrary to antral predominant gastritis. A meta-analysis was unable to prove a significant association between H. pylori eradication and GERD development [8]. The prevalence and risk factors for GERD in an area of low H. pylori prevalence must be examined to provide more information regarding GERD–H. pylori association
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