The role of Helicobacter pylori infection in gastro-oesophageal reflux in Iranian children

Background: The relationship between Helicobacter pylori and gastro-oesophageal reflux disease (GORD) in children is controversial. Aim: To determine the role of H. pylori infection and GORD in children living in a region which is endemic for H. pylori infection. Methods: A cross-sectional study was undertaken in 263 children aged 3-18 years, all of whom had symptoms of GORD and underwent upper gastro-intestinal endoscopy. H. pylori status was determined by conventional rapid urease test and Giemsa staining of antral and cardiac biopsies. Biopsies of the oesophagus and gastric mucosa were obtained from the lower oesophagus, the antrum and cardia according to standard protocol. Results: Of the 263 patients, 81 (31.5%) had GORD and 162 (61.5%) had gastritis. There were 59 H. pylori-infected patients (22.4%) and 204 were uninfected. H. pylori infection was detected in 52 (88.1%) of the antral and 10 (1.9%) of the cardiac biopsies. Three (5.1%) of the biopsies revealed infection of both antrum and cardia and in seven (11.8%) only the cardia was infected. The prevalence of H. pylori infection among patients with GORD (13/83, 15%) was significantly lower than in those without GORD (46/180, 26%) (OR 0.54, CI 0.27-0.93, p<0.05). The prevalence of H. pylori infection among those with gastritis (48/162, 30%) was significantly higher than in those without gastritis (11/101, 10.8%) (OR 3.44, CI 1.69-7.015, p<0.001). Conclusion: H. pylori infection might protect against GORD.