Considering that the role of Helicobacter pylori
infection in
gastroesophageal reflux and
reflux esophagitis (
GERD) is still controversial and that the role of virulence markers of the bacterium has not been evaluated in most studies of
GERD, we investigated the association among H. pylori
infection with cagA-positive and -negative strains, corpus
gastritis, and
GERD in a large group of patients by controlling for confounding factors. We studied prospectively 281 consecutive adult patients: 93 with
GERD and 188 controls. H. pylori
infection status was diagnosed by culture, by the preformed
urease test, with a
carbolfuchsin-stained smear, and by histology. The cagA status was determined by PCR of H. pylori isolates and gastric biopsy specimens. H. pylori
infection was diagnosed in 191 (68.0%) of 281 patients. Among the 93 patients with
GERD, 84 presented with mild or moderate
esophagitis and 9 presented with severe
esophagitis. In the multivariate analysis, the age of the patients and the degree of oxyntic
gastritis were associated with
GERD. Among the strains isolated from patients with
GERD and from the control group, 24.4 and 66.9%, respectively, were positive for cagA (P < 0.001). Compared to
infection with cagA-negative strains,
infection with cagA-positive H. pylori strains was associated with a more intense
gastritis in the corpus (P = 0.001). cagA status (odds ratio [OR] = 0.16, 95% confidence interval [CI] = 0.07 to 0.40),
gastritis of the corpus (OR = 0.69, 95% CI = 0.48 to 0.99), and age (OR = 1.04, 95% CI = 1.01 to 1.07) were associated with
GERD. In conclusion, the study provides evidence supporting the independent protective roles of cagA-positive H. pylori strains and the degree of corpus
gastritis against
GERD.