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Background  Reflux esophagitis (RE) and absence of  Helicobacter pylori  (non- H. pylori ) are considered to be associated with the progression to long-segment Barrett’s esophagus (LSBE). However, it is difficult to assess this association because RE and  H. pylori  status can change during follow-up. Additionally, the association between  H. pylori  eradication and LSBE remains unclear.    Methods  A total of 11,493 asymptomatic Japanese subjects who underwent medical check-ups and were endoscopically diagnosed with short-segment Barrett’s esophagus (SSBE) between May 2006 and December 2015 were enrolled. The hazards of progression to LSBE were compared between time-varying RE and  H. pylori  infection/eradication by time-dependent multivariable Cox proportional hazards models.    Results  A total of 7637 subjects who underwent additional medical check-ups after being diagnosed with endoscopic SSBE were analyzed. Subjects with RE and without current/past  H. pylori  infection were strongly associated with a higher rate of progression to LSBE (adjusted hazard ratio [HR]: 7.17, 95% confidence interval [CI]: 2.48–20.73,  p  < 0.001 for RE and non- H. pylori  vs. non-RE and  H. pylori  groups). Subjects with  H. pylori  had a lower rate of progression to LSBE (adjusted HR: 0.48, 95% CI: 0.22–1.07,  p  = 0.07 for  H. pylori  vs. non- H. pylori ). Hazards of progression to LSBE were still lower in the  H. pylori  eradication group than that of the non- H. pylori  group (adjusted HR: 0.51, 95% CI: 0.18–1.46,  p  = 0.21).    Conclusions  RE and non- H. pylori  were associated with the progression to LSBE, considering the changes in exposures.  H. pylori  infection was associated with the prevention of the development of LSBE irrespective of RE. The environment preventive of the development of LSBE persists for at least a few years after  H. pylori  eradication.

bmc gastroenterology

Relationship between time-varying status of reflux esophagitis and Helicobacter pylori and progression to long-segment Barrett’s esophagus: time-dependent Cox proportional-hazards analysis