HP
infection of the stomach is not a risk factor for reflux oesophagitis, and may even protect against reflux oesophagitis. HP eradication may lead to an accelerated development of
GERD in
duodenal ulcer disease patients. It is unknown whether this is also true for HP positive patients who do not suffer from
duodenal ulcer disease. HP eradication may decrease the efficacy of
acid secretion lowering drugs such as
Proton Pump Inhibitors and H2-Receptor Antagonists. It is unclear whether this has any practical consequences, but it cannot be excluded that some patient may need an increased dose of
acid secretion lowering drugs after HP eradication for control of symptoms and lesions of
GERD. There are conflicting data on the possibility that long-term
proton pump inhibitor treatment may accelerate the development of
atrophic gastritis in Helicobacter pylori positive patients. The possible acceleration of
atrophic gastritis development in HP positive patients using strong
acid secretion inhibitors is the strongest argument in favour of eradicating HP in patients receiving long term potent
acid inhibition, especially
GERD patients. In view of the uncertainty concerning these data, both eradicating and non eradicating HP in patients with
GERD can be defended.