High Serum Pepsinogen I and Low Seroprevalence of Helicobacter Pylori in Chinese Patients with Nonerosive Reflux Disease

The prevalence of gastroesophageal reflux disease (GERD), including nonerosive reflux disease (NERD), is increasing in Asia where H. pylori infection is highly endemic. The role of H. pylori and pepsinogen (PG) has not been evaluated in most studies of NERD, and whether they play a role in GERD remains controversial. This study aimed to determine the demographic and serologic characteristics of Chinese patients with NERD. We prospectively enrolled 69 consecutive NERD patients, and as controls, 69 age- and gendermatched subjects who received endoscopy as a part of their annual health check-up. Rate of H. pylori IgG seropositivity, and serum levels of pepsin precursors (PGⅠ and PGⅡ) and gastrin were measured for each subject. Differences were analyzed using the Chi-square and Mann-Whitney U-test. The H. pylori IgG seropositive rate was lower in NERD patients than in controls (26/69, 37.7% vs. 41/69, 59.4%; p＜0.05). PGⅠ level was higher (144.7±10.7ng/ml vs. 75.4±6.4ng/ml; p＜0.001) and PGⅠ/Ⅱ ratio (14.4±10.7 vs. 9.1±0.7; p＜0.001) was higher in NERD patients than in controls, but both groups had similar PGⅡ (12.0±0.8ng/ml vs. 10.5±1.1ng/ml, p=0.466) and gastrin levels (69.1±7.1pg/ml vs. 81.8±9.6pg/ml, p=0.3l8). Chinese patients with NERD exhibit hyperpepsinogenemia I and a lower seropositive rate of H. pylori than age-matched controls. These results indicate a pivotal role of hyperacidity and possible protective role of H. pylori in this subset of GERD patients.