Association between Helicobacter pylori and Barrett's Esophagus: A case-control study

Lori A. Fischbach, David Y. Graham, Jennifer R. Kramer, Massimo Rugge, Gordana Verstovsek, Paola Parente, Abeer Alsarraj, Stephanie Fitzgerald, Yasser Shaib, Neena S. Abraham, Anna Kolpachi, Swapna Gupta, Marcelo F. Vela, Maria Velez, Rhonda Cole, Bhupinderjit Anand, Hashem B. El Serag

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37 Scopus citations

Abstract

OBJECTIVES: The estimated association between Helicobacter pylori and Barrett's esophagus (BE) has been heterogenous across previous studies. In this study, we aimed to examine the association between H. pylori and BE and to identify factors that may explain or modify this association. METHODS: We conducted a case-control study in which we used screening colonoscopy controls recruited from primary care clinics as our primary control group in order to minimize selection bias. All participants underwent an esophagogastroduodenoscopy with gastric mapping biopsies. We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the association between H. pylori and BE while controlling for confounders. RESULTS: We identified 218 cases and 439 controls. The overall OR for the association between H. pylori and BE after controlling for age and white race was 0.55 (95% CI: 0.35-0.84). We observed an even stronger inverse association (OR: 0.28; 95% CI: 0.15, 0.50) among participants with corpus atrophy or antisecretory drug use ≥1 time per week (factors thought to lower gastric acidity), and no inverse association in patients without these factors (OR: 1.32; 95% CI: 0.66, 2.63). CONCLUSIONS: The association between H. pylori and a decreased risk for BE appears to occur in patients with factors that would likely lower gastric acidity (corpus atrophy or taking antisecretory drugs at least once a week).

Original languageEnglish (US)
Pages (from-to)357-368
Number of pages12
JournalAmerican Journal of Gastroenterology
Volume109
Issue number3
DOIs
StatePublished - Mar 2014

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Fischbach, L. A., Graham, D. Y., Kramer, J. R., Rugge, M., Verstovsek, G., Parente, P., Alsarraj, A., Fitzgerald, S., Shaib, Y., Abraham, N. S., Kolpachi, A., Gupta, S., Vela, M. F., Velez, M., Cole, R., Anand, B., & El Serag, H. B. (2014). Association between Helicobacter pylori and Barrett's Esophagus: A case-control study. American Journal of Gastroenterology, 109(3), 357-368. https://doi.org/10.1038/ajg.2013.443