Increased body mass index after H. pylori eradication for duodenal ulcer predisposes to erosive reflux esophagitis.

A higher body mass index (BMI) may lead to a more adverse outcome of reflux esophagitis. The study aimed to determine whether increased BMI after H. pylori eradication in duodenal ulcer patients predisposes to erosive reflux esophagitis. Four hundred fifty-nine patients with Helicobacter pylori-positive duodenal ulcers but without reflux esophagitis were evaluated. Serial BMIs were collected before therapy and on the 2nd, 6th, and 12th months after H. pylori eradication. New-onset reflux esophagitis was recorded. In 350 patients with complete follow-up, mean BMI increased from the second month after H. pylori eradication (P<0.001). H. pylori eradication also led to a net increase of BMI >1.5 kg/m in nearly 20% of patients in the 12-month follow-up, whereas new-onset of reflux esophagitis was noted in 16.3% (57/350). Baseline BMI, prevalence rate of hiatus hernia, and net increase of BMI were higher in patients with new-onset reflux than in those without (P<0.05). Multiple logistic regression confirmed higher baseline BMI, hiatus hernia, and net BMI increase >1.5 kg/m after H. pylori eradication were independently associated with new-onset reflux esophagitis (P<0.05). Eradication of H. pylori may lead to a significant net increase of BMI in patients with duodenal ulcers. Such BMI gain, as well as higher baseline BMI and hiatus hernia, predisposes to new-onset reflux esophagitis after H. pylori eradication.