Twelve studies were included in the review (n=4,058 patients): seven RCTs and five cohort studies. The length of follow-up ranged from six to 24 months. The quality of RCTs varied from 2 to 5 out of 5 points; the quality of cohort studies ranged from 4 to 7 out of 9 points.
There were no statistically significant differences between persistent Helicobacter pylori (H. pylori) group compared with the H. pylori-eradicated group in terms of the frequency of post-eradication gastro-oesophageal reflux disease in the RCTs (six RCTs and five cohort studies on erosive gastro-oesophageal reflux disease; n=4,058 patients; I2=27).
Subgroup analyses found no statistically significant differences between persistent Helicobacter pylori groups in RCTs using erosive gastro-oesophageal reflux disease as the outcome (six RCTs; n=2,085 patients; I2=31%), RCTs using symptomatic gastro-oesophageal reflux disease as the outcome (five RCTs; n=760 patients; I2=31%), or the five cohort studies (n=1,895 patients; I2=35%).
In patients with peptic ulcer disease, there was no difference between the frequency of post-eradication gastro-oesophageal reflux disease in the H. pylori-eradicated group compared with the persistent H. pylori group in the RCTs (five RCTs; I2=16%). In the four cohort studies, there was a statistically greater rate of post-eradication gastro-oesophageal reflux disease in the H. pylori-eradicated group compared with the persistent H. pylori group with peptic ulcer disease (OR 2.04, 95% CI 1.08 to 3.85; I2=6%).
Sensitivity analysis: There was no difference between the frequency of post-eradication gastro-oesophageal reflux disease in the H. pylori-eradicated group compared with the persistent H. pylori group in either the RCTs or cohort studies grouped by quality (high versus low) or length of follow-up (under 12 months versus 12 months or longer). There was evidence of statistical heterogeneity in the sensitivity analysis of high versus low quality cohort studies (I2=73%).