Long-Term GERD and the Impact of Helicobacter Pylori Infection

Long-term gastroesophageal reflux disease (GERD) followed by the detection of Helicobacter pylori?

Hello, Doctor.
I have been experiencing gastroesophageal reflux disease (GERD) for three years now.
I previously consulted with an otolaryngologist and a pulmonologist, and finally saw a gastroenterologist who diagnosed me with GERD.
Over these three years, I have undergone annual endoscopies.
I often feel reflux when lying flat or on my stomach, which leads to coughing, and sometimes I cough up yellow phlegm (I have regular health check-ups with chest X-rays, and my lungs are fine).
After the endoscopy, the doctors have consistently noted mild GERD.
This time, a different doctor performed the endoscopy and mentioned that they couldn't even see the GERD.
Since I do not have any other conditions like gastric ulcers, my health insurance does not cover the treatment.
The doctor suggested I consider self-paying for eradication therapy.
I researched online and found that Helicobacter pylori can cause gastric ulcers and, in severe cases, lead to gastric cancer.
However, I also read that after eradication, the risk of developing GERD and esophageal cancer may increase.
I would like to ask the doctor: 1.
I feel reflux but do not experience acidity; could this be due to the alkalinity neutralizing gastric acid caused by Helicobacter pylori? Is it normal to occasionally cough up yellow phlegm with GERD? 2.
Given my GERD, will eradicating Helicobacter pylori make my condition worse? Should I consider self-paying for the eradication? Thank you, Doctor, for your answers.

Ai Qing, 30~39 year old female. Ask Date: 2021/03/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

Symptoms may be related to reflux; medication can be taken to see if there is any improvement, and discontinuation of the medication can help determine if symptoms recur.
Additionally, it is recommended to eradicate Helicobacter pylori.
Whether this will increase reflux can be monitored during treatment.

Reply Date: 2021/03/30

More Info

Long-term gastroesophageal reflux disease (GERD) can significantly impact a person's quality of life, and the presence of Helicobacter pylori (H. pylori) infection may complicate the clinical picture. Let's address your concerns regarding the relationship between GERD and H. pylori, as well as the implications of treatment.

1. Understanding GERD and H. pylori: GERD is characterized by the reflux of stomach contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and cough. The cough you experience, especially if it produces yellow phlegm, could be related to aspiration of refluxed material into the airways, which can irritate the lungs. H. pylori is a bacterium that can inhabit the stomach lining and is known to cause chronic gastritis and peptic ulcers. While it is true that H. pylori can lead to increased gastric acid production, it can also lead to a more alkaline environment in the stomach due to the inflammation it causes, which may affect the acidity of the gastric contents that reflux into the esophagus.

2. Symptoms and H. pylori: The absence of acidic sensations in your reflux could be due to several factors, including the neutralization of stomach acid by the presence of H. pylori or the nature of the refluxate itself. It’s not uncommon for individuals with GERD to experience atypical symptoms, including cough and phlegm production. The yellow phlegm may indicate the presence of mucus or infection, and while it can be associated with GERD, it’s essential to rule out other respiratory issues.

3. Treatment Considerations: Regarding the eradication of H. pylori, it is essential to weigh the benefits and risks. While H. pylori eradication can reduce the risk of gastric ulcers and potentially lower the risk of gastric cancer, there is some debate about its impact on GERD. Some studies suggest that eradicating H. pylori may worsen GERD symptoms in certain individuals, while others indicate that it may improve gastric health overall. The decision to undergo treatment should be based on a thorough discussion with your gastroenterologist, considering your specific symptoms, the severity of your GERD, and your overall health.

4. Self-Payment for Treatment: If your healthcare provider recommends eradicating H. pylori, and you are considering self-paying for the treatment, it is crucial to discuss the potential outcomes and follow-up care. The treatment typically involves a combination of antibiotics and proton pump inhibitors (PPIs) to reduce stomach acid and help heal the stomach lining.

5. Long-Term Management: After H. pylori eradication, ongoing management of GERD may still be necessary. This could involve lifestyle modifications, dietary changes, and possibly continued use of PPIs or other medications to control reflux symptoms. Regular follow-ups with your healthcare provider will help monitor your condition and adjust treatment as necessary.

In conclusion, while H. pylori infection can complicate GERD, the relationship is complex. It’s essential to have an open dialogue with your healthcare provider about your symptoms, treatment options, and the potential risks and benefits of eradicating H. pylori. Your health and comfort should be the primary focus in making these decisions.

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