Elevated waist circumference and excess body weight, but not Helicobacter pylori (H. pylori) therapy forecast novel onset erosive esophagitis.

A study was performed to determine if H. pylori therapy, excess weight of the body, and other anthropometric estimations are linked with incident erosive esophagitis, as a secondary aim of a study (HEROES trial) that evaluated the effectiveness of H. pylori therapy on functional dyspepsia symptoms.

In H. pylori-positive subjects having functional dyspepsia, the upper gastrointestinal endoscopy and anthropometric evaluations were carried out at baseline and after 12 months. The enrolled participants had no baseline reflux symptoms or esophagitis. Participants were randomly allocated to either  antibiotic group (omeprazole, amoxicillin, and clarithromycin; n = 201) or control group (omeprazole plus placebo; n = 203). The occurrence of esophagitis 12 months after randomization, based on the therapy groups, and the link of body mass index and other anthropometric estimations were the major endpoint.

The study incorporated 404 patients (mean age, 46.1 years). The 12-month follow-up endoscopic esophagitis rates for the control and antibiotic arms were 9.4% (19/203) and 10.9% (22/201) respectively. The number required to impair was 67. Baseline anthropometric estimations were carried out in 94% (380/404) of individuals.

The rates for subjects with and without elevated baseline waist circumference were 15.4% (24/156) and 6.7% (15/224), respectively. For normal body weight and overweight subjects, the 12-month follow-up esophagitis rates were found to be 6.0% (10/167) and 13.6% (29/213) respectively. After logistic regression, only the combination of elevated waist and higher body mass index and, but not H. pylori therapy was independently linked with novel-onset esophagitis (Odds ratio 2.88).

H. pylori infection is not a major risk factor for developing reflux esophagitis in a population of individuals having functional dyspepsia. However, increased body mass index, associated with a concomitant increase in waist circumference (combined risk factors for GERD), is considerably related to the development of erosive esophagitis.

Physicians should not be excessively concerned about the risk of developing erosive esophagitis in H. pylori-positive functional dyspepsia patients offered eradication treatment.