H. pylori Infection at Distal Esophageal Mucosa and the Efficacy of Antibiotic Therapy in Patients with GERD/Gastritis

Abstract

Purpose: To understand the relevancy between the efficacy of antibiotic therapy and the H. pylori infection and location in patients with GERD and gastritis, a prospective study was performed with Prevpac in 29 patients with GERD and/or gastritis and positive H. pylori infection detected by a multiplex PCR assay. Methods: This study was performed in 29 patients with GERD and/or gastritis undergoing endoscopy in Evanston Northwestern Healthcare, who had been detected with H. pylori infection by one-step multiplex PCR. The patients were treated with Prevpac and after four weeks of treatment, these patients were examined with second EGD and multiplex PCR was performed again on the biopsies. Results: Of the 29 patients, H. pylori infection was found in the 22 individuals at the distal esophagus, 25 individuals at the corpus/antrum, 4 cases at only the distal esophagus, 7 cases at only the corpus/antrum and 18 cases at both stomach and distal esophagus. After treatment with Prevpac, 59% (17/29) cases became H. pylori negative. In the 22 esophagus infection cases, 11 (50%) cases were still with positive PCR results and in the 25 gastric infection individual, only 7 (28%) cases were positive. In the 18 cases with both gastric and distal esophagus infection, 10 (56%) cases were still positive, but all of the 7 with gastric only infection cases became H. pylori negative (100%). Conclusions: Our results indicate that the H. pylori could live in the distal esophagus. It is suggested that multiple biopsies, especially the specimens from distal esophagus may be needed for the diagnosis of H. pylori infection in some situation. More importantly, our initial results showed that H. pylori located at distal esophagus mucosa are not as sensitive as those at gastric mucosa to the treatment with Prevpac.Table: H. pylori Positive Location Before TreatmentTable: H. pylori Positive Location After Treatment