Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux

Background. The association of H. pylori and hiatal hernia in patients with gastroesophageal reflux disease, in terms of acidity and esophageal motility, is not well defined. The purpose of this work was to assess whether, in patients with gastroesophageal reflux, the presence of H. pylori and hiatal hernia affects the severity of esophagitis. Methods. Reflux symptoms, endoscopy, H. pylori, esophageal manometry, and 24-h pH monitoring were evaluated in 37 patients with esophageal reflux and 14 healthy volunteers. Results. A total of 75.6% of patients with esophageal reflux was positive for H. pylori; 81% had hiatal hernia, and only 43.2% showed an acid score by 24-h pHmetry. Esophageal reflux patients with H. pylori, hiatal hernia, and an acid score demonstrated higher acid parameters compared with those in healthy volunteers. Patients with an acid score who were negative for H. pylori tended toward more acid reflux events than patients with an acid score who were positive for H. pylori, a difference that did not reach significance. The same situation existed with patients with an acid score and hiatal hernia who were negative for H. pylori, but the tendency did not achieve significance. Independent analysis of patients with Savary-Miller stage II and III esophagitis showed results that were not different from the combined analysis of stage II and III patients. Amplitude and contraction-duration parameters of the esophageal wave, and the number of high-pressure and prolonged contractions were not different among the reflux groups. Wave amplitude in the lower third of the esophagus was significantly lower in esophagitis stage III patients with hiatal hernia and in esophagitis stage II and III patients, combined, with H. pylori, compared with findings in the healthy volunteers. Conclusions. These results suggest that H. pylori and hiatal hernia in patients with esophageal reflux do not constitute risk factors that affect the severity of esophagitis.