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Positive Association Between Helicobacter pylori and Gastroesophageal Reflux Disease in Children

Moon, Aeri*; Solomon, Aliza*; Beneck, Debra; Cunningham-Rundles, Susanna

Journal of Pediatric Gastroenterology & Nutrition: September 2009 - Volume 49 - Issue 3 - p 283–288
doi: 10.1097/MPG.0b013e31818eb8de
Original Articles: Gastroenterology

Objectives: The role of Helicobacter pylori (H pylori) in gastroesophageal reflux disease (GERD) remains controversial, particularly in children, because there are limited published data. Adult studies suggested that H pylori infection may protect against GERD by causing atrophic gastritis, which leads to reduced gastric acid secretion. The objective of our study was to determine the role of H pylori infection in the development of GERD in a pediatric population.

Patients and Methods: A retrospective analysis of 420 patients (M:F = 214:206) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006 was conducted. Patient demographics, clinical indications for EGD and the prevalence of reflux esophagitis (RE), the biomarker for GERD, in 2 groups, H pylori positive and H pylori negative, were reviewed. The prevalence of RE in the H pylori–positive and H pylori–negative groups was further analyzed on the basis of sex and age (<1 year, 1–10 years, >10 years). The mean age of the study population was 8.2 years (range 0–20 years). The clinical indications for EGD were as follows: recurrent abdominal pain (n = 186, 44%), malabsorption (n = 80, 19%), persistent vomiting (n = 80, 19%), suspected eosinophilic gastrointestinal disorders (n = 63, 15%), and others such as upper gastrointestinal bleeding or inflammatory bowel disease surveillance (n = 11, 3%). Statistical analysis was performed by using χ2 test, Fisher exact test, and multivariate logistical regression analysis.

Results: Among the 420 patients, 16 patients (3.8%) were positive for H pylori and 167 patients (39.8%) were found to have RE. Thirteen patients with H pylori were found to have histologic evidence of RE. The prevalence of RE in the H pylori–positive population was 81.3% compared with 38.1% in the H pylori–negative population (P ≤ 0.05). There were no patients with H pylori in the youngest age group. In the second age group (1–10 years), 100% of the H pylori–positive patients had RE, whereas 44.6% of the H pylori–negative patients had RE (P ≤ 0.05). Both male and female patients with H pylori had a higher prevalence of RE, 77.8% and 85.7%, respectively. On a multivariate logistical regression, for the overall study cohort, H pylori–positive patients had an odds ratio of 5.79 of developing RE compared with H pylori–negative patients (P ≤ 0.05).

Conclusions: Our study results indicate that there is a significantly higher prevalence of RE in an H pylori–infected cohort independent of age or sex. The findings suggest that H pylori infection in children is positively associated with RE.

*Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, USA

Department of Pathology, USA

Department of Pediatrics, Division of Hematology/Oncology, Host Defenses Program, Weill Medical College, Cornell University, New York, NY, USA

Received 26 April, 2007

Accepted 21 September, 2008

Address correspondence and reprint requests to Aeri Moon, MD, Weill Medical College of Cornell University, 505 East 70th St, 3rd Floor, New York, NY 10021 (e-mail:

Dr Solomon is the recipient of an NIH NCIR25 fellowship. The study was supported in part by NIH NCI P30 CA29502, NIH NCI R25 105012, and the Children's Cancer and Blood Foundation.

The authors report no conflicts of interest.

© 2009 Lippincott Williams & Wilkins, Inc.