Effects of Intragastric Helicobacter pylori Distribution on Clinical Presentation, Upper Gastrointestinal Endoscopy, Esophageal Manometry, and pH–Impedance Metrics

<b>Background:</b> The relationship between <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection and gastroesophageal reflux disease (GERD) remains a topic of ongoing debate. In particular, the intragastric distribution of <i>H. pylori</i>-whether localized in the antrum or corpus-may influence gastric acid secretion and esophageal physiology in different ways. However, its potential effects on esophageal motility and reflux parameters have not been comprehensively evaluated using combined diagnostic tools. This study aimed to assess whether <i>H. pylori</i> positivity, based on its histologically confirmed intragastric localization, is associated with alterations in endoscopic, manometric, and reflux monitoring findings in patients with typical GERD symptoms. <b>Methods:</b> This retrospective study included 213 patients with typical reflux symptoms who underwent upper gastrointestinal endoscopy with gastric biopsies, high-resolution esophageal manometry (HREM), and 24 h multichannel intraluminal impedance-pH (MII-pH) monitoring. Based on histopathology, patients were classified into three groups: <i>H. pylori</i>-negative, antrum-predominant infection, and corpus-predominant infection. Clinical symptoms, endoscopic findings, reflux characteristics, and esophageal motility parameters were compared. <b>Results:</b> Of 213 patients, 90 were <i>H. pylori</i>-positive (60 antrum-predominant, 30 corpus-predominant). There were no significant differences between groups in terms of typical GERD symptoms, endoscopic esophagitis, DeMeester scores, acid exposure time, or mean nocturnal baseline impedance (MNBI). Nausea and chronic laryngitis were significantly more frequent in antral <i>H. pylori</i>-positive patients. Notably, contraction front velocity (CFV) was significantly lower in patients with antral <i>H. pylori</i> compared with <i>H. pylori</i>-negative individuals (<i>p</i> = 0.002), indicating subtle slowing of esophageal peristalsis. Although this reduction in CFV did not correlate with symptom severity or bolus clearance, it may represent early functional impairment of esophageal motility. <b>Conclusions:</b> Although <i>H. pylori</i> infection-particularly when antrum-predominant-is not associated with increased reflux burden or esophagitis, it may contribute to extra-esophageal symptoms and minor motility alterations such as reduced CFV. These findings suggest that routine <i>H. pylori</i> eradication in GERD patients may not be necessary solely based on reflux parameters. However, treatment decisions should be individualized based on symptom profiles and endoscopic findings, including the presence of peptic ulcers, premalignant gastric lesions, or a family history of gastric malignancy, in accordance with general <i>H. pylori</i> eradication criteria.