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Background: Current gold standard for the diagnosis of gastroesophageal reflux disease (GERD) is 24-hour pH metry though it fails to detect non-acidic reflux. The sensitivity of 24-hour pH metry alone (both catheter-based and Bravo capsule) is questionable, especially if gastric acid secretion is low due to reduced parietal cell mass, Helicobacter pylori-induced gastric atrophy and antisecretory therapy. Accordingly, we analyzed the diagnostic ability of 24-hour pH metry as compared to impedance monitoring in relation to the gastric pH without antisecretory therapy., Methods: A retrospective analysis of prospectively collected data from 150 patients with suspected GERD undergoing a 24-hour pH impedance study was done., Results: Among 150 patients with symptoms suggestive of GERD, 106 (70.6%) had confirmed GERD diagnosed either by 24-hour pH metry alone (10 [9.4%]), impedance monitoring alone (49 [46.2%]) or both (47 [44.3%]). Abnormal reflux of acidic and non-acidic gastric contents was detected by 24-hour pH metry and 24-hour impedance monitoring in 57/106 (53.7%) and 96/106 (90.5%) of patients, respectively (p < .00001). Patients with GERD diagnosed by 24-hour impedance monitoring had a higher mean gastric pH (2.9 [median 1.3, IQR 5.3]) than those diagnosed by 24-hour pH metry (2.1 [median 1.4, IQR 2.6]) or both (1.6 [median 1.2, IQR 2.1]) (p = 0.001)., Conclusion: Twenty-four-hour impedance monitoring detects GERD more often than 24-hour pH metry. Patients with higher mean gastric pH leading to non-acidic reflux were more often diagnosed by 24-hour impedance monitoring than 24-hour pH metry. Thus, 24-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of GERD, particularly in presence of reduced gastric acid secretion., (© 2023. Indian Society of Gastroenterology.)

Background: Nocturnal acid breakthrough (NAB) may differ based on duration of proton pump inhibitor (PPI) action and Helicobacter pylori (H. pylori) infection; NAB may influence esophageal acidification (EA) and mucosal damage. Dexlansoprazole, a long-acting PPI, was not compared with omeprazole for NAB, gastric acid suppression, and EA in relation to H. pylori infection., Methods: In this prospective open-label comparative observational study, gastroesophageal reflux disease (GERD) patients were evaluated using 24-h dual-channel pH-impedance monitoring while on dexlansoprazole (60 mg, n = 39) and omeprazole (20 mg, n = 41) to study the degree of gastric acid suppression, esophageal acid exposure, and NAB (primary outcome measures). H. pylori was detected by rapid urease test and histology., Results: NAB tended to be frequent with omeprazole than dexlansoprazole (33/41 [80.5%] vs. 23/39 [59%]; p = 0.06). Though nocturnal mean esophageal pH was comparable between the dexlansoprazole and omeprazole groups, its duration was less with the former (181.5 [15.2-334.2] vs. 283 [158-366] min, p = 0.03). NAB was as frequent in the H. pylori-infected than the non-infected group (11/19 [57.9%] vs. 45/61 [73.8%]; p = 0.1). The nocturnal gastric and esophageal pH in the H. pylori-infected group was higher than in the non-infected group (4.6 ± 1.7 vs. 4 ± 1.6, p = 0.157; 6.1 ± 0.6 vs. 5.8 ± 0.6, p = 0.128). Dexlansoprazole tended to increase 24-h and nocturnal mean gastric pH among H. pylori-infected more than omeprazole (5.9 ± 1.1 vs. 4.2 ± 1.7, p = 0.023; 5.7 ± 1.2 vs. 3.8 ± 1.5, p = 0.006)., Conclusion: Dexlansoprazole is more effective than omeprazole in suppressing gastric acid secretion, resulting in lesser EA and NAB, particularly in the presence of H. pylori., (© 2022. Indian Society of Gastroenterology.)

Background: Indian population-based studies on the prevalence and risk factors for gastroesophageal reflux disease (GERD) are scanty, and a meta-analysis and a meta-regression of prevalence and risk factors based on the existing data have not yet been reported., Methods: A systematic review of all the available publications from India reporting data regarding prevalence and risk factors of GERD was performed. Heterogeneity was assessed using I 2 statistics. The meta-analysis was undertaken to measure the average proportion reported in the existing studies, and meta-regression models were used to explore the risk factors for it., Results: The nine studies included 20,614 subjects; the prevalence of GERD ranged from 5% to 28.5%. The summary effect size (weighted average proportion) estimated by meta-analytic model was 0.1415 (95% confidence interval [CI] 0.099 to 0.197). The results for the test of heterogeneity that included tau 2 (0.37, 95% CI 0.21 to 1.80), I 2 (98.9%, 95% CI 98.01 to 99.77), and the Q-statistic (707.670; p < 0.0001) suggested high heterogeneity in the effect sizes. The pooled proportion of GERD (random-effects model) was 15.573 (95% CI 11.046 to 20.714). In the meta-regression model, sample size (p = 0.005) explained about 50% of the heterogeneity., Conclusion: The pooled prevalence of GERD in the Indian population is 15.6 (95% CI 11.046 to 20.714). The risk factors were age, body mass index (BMI), non-vegetarian diet, tea/coffee intake, tobacco, and alcohol consumption. However, there was significant heterogeneity in the studies.

Background: Studies on frequency and risk factors of gastroesophageal reflux disease (GERD) in the rural Indian population are scanty., Methods: This household survey was undertaken by the trained interviewers in the adult population (≥ 18 years) in four villages in northern India using translated-validated Enhanced Asian Rome III and hospital anxiety and depression questionnaires., Results: Of 2774 subjects, 2019 (72.8%) had no heartburn. Heartburn frequency was as follows: 314 (11.3%) once/week, 143 (5.2%) twice/week, 85 (3.1%) thrice/week, 69 (2.5%) four times/week, 48 (1.7%) five times/week, 18 (0.6%) six times/week, 41 (1.5%) daily, 37 (1.4%) > once daily. A total of 298 (10.7%) had GERD (definition: heartburn > twice/week). Older age (36.5 vs. 35 years), non-Hindu religion (7, 2.4% vs. 30, 1.2%), lower education (127, 42.6% vs. 789, 31.9%), lower socioeconomic class (94, 31.5% vs. 517, 20.9%) and income (below Indian National Rupees [INR] 458; 105, 35.2% vs. 599, 24.2%), non-vegetarian diet (15, 5% vs. 105, 4.2%), intake of tea/coffee (260, 87.2% vs. 1687, 68.1%), carbonated soft drinks (216, 72.5% vs. 1234, 49.8%), and alcohol (48, 16.1% vs. 313, 12.6%), tobacco chewing (116, 38.9% vs. 681, 27.5%), and smoking (105, 35.2% vs. 672, 27.1%) were associated with GERD on univariate analysis. On multivariate analysis, body mass index > 25 kg/m 2 (odds ratio [OR] 1.23; 95% CI 0.88-1.71), predominant rice eating (1.13; 0.74-1.74), tobacco chewing and smoking (1.68; 1.24-2.30 and 1.36; 0.99-1.88), and alcohol (1.2; 0.78-1.83) and carbonated soft drinks (2.48; 1.79-3.44) intake were associated with GERD. A total of 122 (41%) had associated functional dyspepsia. Psychological comorbidities were commoner among those with than without GERD., Conclusion: In this rural Indian population, 10.7% had GERD and predominant rice eating, tobacco chewing, and carbonated soft drink intake were the risk factors. Psychological comorbidities were common.

The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being  < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H 2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.

Background: Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD., Methods: In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods., Results: Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003-1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms., Conclusion: 7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.

Multiple factors play a role in the pathogenesis of gastroesophageal reflux disease (GERD). Two landmark studies showing higher concordance of disease in monozygotic than dizygotic twin pairs suggested the role of host genetic factors in its pathogenesis. Recent studies have shown that genetic polymorphism in genes influencing host's inflammatory response, drug metabolism, cell cycle regulation, xenobiotic pathways, DNA repair, mutagenesis, esophageal sensory function and gene silencing are associated with risk of GERD and its sequelae-Barrett's esophagus and esophageal adenocarcinoma. However, more studies on larger sample size are needed before reaching a definite conclusion on the role of an individual gene.

Background and Aim: The relationship between gastroesophageal reflux disease (GERD) and Helicobacter pylori is controversial. We evaluated endoscopic, 24-h gastric and esophageal acid profile among patients with GERD in relation to H. pylori, as the latter might alter gastric acid secretion., Methods: Patients with GERD (n = 123), who were not on acid-suppressive drugs, and had not received anti-H. pylori therapy, underwent gastroduodenoscopy and tests for H. pylori detection. Esophageal manometry, 24-h pH metry, serum pepsinogen-I (PG-I), PG-II and gastrin-17 ELISA were done in all these patients. Univariate and multivariate analyses were performed to assess independent predictors for erosive esophagitis (EE)., Results: Of 123 patients (mean age 40.5 [13.1] years, 85 [69.1%] men), 59 (47.9%) had H. pylori infection. EE was more common in H. pylori non-infected than infected (49 vs. 32, p < 0.001). Among patients older than 40 years, absence of H. pylori was associated with lower esophageal pH and longer reflux (p = 0.02 and p < 0.001, respectively). PG-I/PG-II ratio was lower in H. pylori infected subjects (p < 0.001). In patients with higher LA grade of esophagitis, elevated PG-I levels and PG-I/PG-II ratio were associated with more acidic stomach (p = 0.04 and p = 0.01, respectively). Multivariate analyses showed low gastrin-17 (p = 0.016), higher age (p = 0.013), hiatus hernia (p = 0.004) and absence of H. pylori (p = 0.03) were independent predictors for risk of EE., Conclusion: H. pylori infection is associated with less acidic stomach and less severe GERD. Low gastrin-17, higher age, hiatus hernia and absence of H. pylori were the best predictors for EE risk.

Objectives: We aimed at evaluating the role of interleukin-1B (IL-1B) and IL-1RN polymorphisms, which may modulate the gastric mucosal expression of IL-1beta, thus altering acid secretion, which influences the severity of gastroesphageal reflux disease (GERD)., Methods: In a prospective study, 144 patients with GERD (diagnosed by at least two of these criteria: Carlsson-Dent score of 6, endoscopic evidence of GERD, histopathological evidence of esophagitis, percentage time esophageal pH <4 for >5% on 24-h pH monitoring, and response to omeprazole 20 mg/day) and 368 healthy controls were genotyped for IL-1B-511 C/T and IL-1RN VNTR polymorphism (by PCR-restriction fragment length polymorphism (RFLP) and PCR, respectively). Gastric mucosal IL-1beta levels (picogram/milligram of biopsy sample) were measured (using enzyme-linked immunosorbent assay (ELISA)) in 71 patients. Helicobacter pylori diagnosis was conducted using anti-H. pylori immunoglobulin G (IgG) ELISA., Results: Patients (41.1+/-13.3 years old, 96 (66.7%) men) were comparable with healthy controls (43.4+/-11.8 years old, 238 (64.7%) men) with respect to age and gender. The IL-1B-511 CC genotype and C allele were associated with higher risk of GERD than the TT genotype (P=0.01, odds ratio (OR)=2.0, 95% confidence interval (CI)=1.12-3.57) and the T allele (P=0.04, OR=1.3, 95% CI=1.0-1.7), respectively. TT and C noncarriers had more IL-1beta than CT (33.2 (2.6-161.3) vs. 16.7 (2.8-121.9), P=0.04) and C carriers (33.2 (2.6-161.3) vs. 15.16 (1.5-121.9), P=0.04), respectively. IL-1RN "1,2" and "2 carriers" had higher risk (P<0.001, OR=2.0, 95% CI=1.31-3.1; P=0.01, OR=1.6, 95% CI=1.1-2.4, respectively). "2,2" Had lower IL-1beta levels than both "1,1" and "1,2" (9.2 (1.5-70.7) vs. 26.8 (5.7-161.3), P=0.006; 9.2 (1.5-70.7) vs. 24.4 (2.6-78.0), P=0.02). However, "2 carriers" tended to have lower IL-1beta levels than "2 noncarriers" (21.7 (1.5-78.0) vs. 26.8 (5.7-161.3), P=0.09). The IL-1B-511*T/IL-1RN*1 ("T1") haplotype showed lower risk (P=0.05, OR=0.7, 95% CI=0.5-1.0). "T1" had higher IL-1beta levels than both "T1 carriers" and "T1 noncarriers" (43.5 (18.2-161.3) vs. 23.9 (2.6-121.9), P=0.02; 43.5 (18.2-161.3) vs. 10.9 (1.5-82.6), P=0.06, respectively). The presence of H. pylori infection was associated with the stronger risk of the IL-1B-511*CC genotype. The "T1" haplotype was strongly protective against GERD among patients with H. pylori infection., Conclusions: The T1 haplotype was associated with the reduced risk of GERD, particularly among patients with H. pylori infection, probably because of higher gastric mucosal IL-1beta levels.

We report the case of a patient with gastroesophageal reflux disease who developed gastric atrophy and intestinal metaplasia (IM) while on 20-year treatment with proton pump inhibitors. This is perhaps the first report in human beings. A 74-year-old man, who presented with heartburn, showed abnormally high gastric pH (average 6.57) on 24-hour dual channel pH-metry even after discontinuing acid suppressive drugs for one month. No significant esophageal acid exposure was noted, which may be related to an impairment of the acid secreting capacity of the stomach (percentage time esophageal pH<4 during 24-h period 0.3%). Upper gastrointestinal endoscopy was normal except for the prominent submucosal vessels in the body and fundus suggesting gastric atrophy. Histopathological examination of multiple biopsies from the body and antrum of stomach showed signs of gastric atrophy and IM. Rapid urease test and histopathology of gastric biopsies were negative for Helicobacter pylori. Anti-H.pylori IgG ELISA however, was positive. Patient was asked to stop all anti-secretory drugs and only prokinetics were prescribed following which his symptoms markedly improved. On follow-up, in April 2007, he developed symptoms of peripheral neuropathy; serum vitamin 812 level was low. He responded to parenteral vitamin 812 therapy. 24-h dual channel pH-metry repeated after one and a half years showed persistently high gastric pH (average pH 6.76). The patient remained well after discontinuing proton pump inhibitors and continuing prokinetics and vitamin B12 injections.

Objective: In patients with gastroesophageal reflux disease (GERD), refluxed gastric juice can damage the esophagus, and hence the more acidic the juice, the more the expected damage. Nocturnal acid breakthrough (NAB) is known to occur in GERD patients on treatment with proton-pump inhibitors (PPIs); however, whether this causes esophageal acidification and symptoms is controversial. The aims of this study were to investigate the relationship between gastric acid and the severity of GERD and the esophageal acidification and symptoms during NAB., Material and Methods: Patients with GERD were evaluated using endoscopy (graded according to the Los Angeles (LA) classification), manometry and 24-h dual-channel pH-metry for esophageal and gastric acid profile and follow-up pH-metry while on PPIs for NAB., Results: In 61 patients (39.2+/-12.8 years, 40 M) the endoscopic grading was endoscopy negative (ENRD) in 19 (32%), endoscopic (ERD) in 40 (68%), (LA-A in 25, 42.4%, LA-B in12, 20.3%, peptic stricture in 2, 3.4%, and Barrett's esophagus in 1, 1.7%) and 2 patients were unclassified. Patients in the different groups had comparable gastric acid profiles, though esophageal acid exposure was different (LA-B and above versus ENRD, p=0.007; LA-B and above versus LA-A, p=0.003). Patients with NAB (7/18, 39%) had lower gastric pH than patients without NAB (p=0.003) though average esophageal pH and esophageal acid exposure were comparable. Frequency of nocturnal symptoms was comparable in patients with or without NAB (2/7 versus 3/11, p=NS). Lower esophageal sphincter (LES) pressure was negatively correlated with average gastric pH., Conclusions: Although severity of GERD is related to esophageal acid exposure, it does not correlate to gastric acid. No difference was found in esophageal acid exposure and nocturnal symptoms in patients with or without NAB.

Gastro-oesophageal reflux disease is a multifactorial disease. The roles of environmental, dietary, and host physiological factors are well established. However, the plausible role of Helicobacter pylori infection in gastro-oesophageal reflux disease is still controversial. Furthermore, the role of host genetic factors remains unidentified. Extensive PubMed review of the previous literature has revealed that H. pylori may be negatively associated with gastro-oesophageal reflux disease. Ethnic or inter-individual variations in response to H. pylori infection may also determine disease outcome. Thus, host genetic factors may play an important role in deciding the final outcome of disease. Limited studies have shown that homEM ofCYP2C19, b allele (val105) ofGSTP1, T allele of IL1B-31, 2/2 genotype of IL1RN +2018, 2/2 genotype of IL-10-1082, A/A genotype of CCND1 G870A, and homozygous variant of XPC PAT gene are potential risk factors for the development of gastro-oesophageal reflux disease or its complications such as Barrett's oesophagus and oesophageal adenocarcinoma. There is scant data on the relationship between gastro-oesophageal reflux disease and H. pylori in India, and therefore, further studies are directly required to explore this issue.

Esophageal motility disorders (EMDs) form a significant part of a busy endoscopist's practice. Endoscopy plays an all-encompassing role in the diagnosis and management of EMDs including achalasia cardia. The focus on in-vogue third-space endoscopic procedures such as per-oral endoscopic myotomy often digresses the important role of endoscopy. Endoscopic evaluation forms the part of standard first-line evaluation of any dysphagia and serves to rule out a secondary cause such as an esophagogastric junction malignancy and eosinophilic esophagitis. Moreover, endoscopic evaluation may itself provide corroborative evidence that may contribute to the diagnosis of the motility disorder. Achalasia cardia may present with a wide spectrum of endoscopic findings from being entirely normal and the well-known and pathognomonic dilated sigmoid-shaped esophagus with food residue, to lesser-known ornate signs. The evidence on the role of endosonography in EMDs is conflicting and largely restricted to evaluation of pseudoachalasia. High-resolution manometry (HRM) remains the gold standard in the diagnosis of EMDs. Endoscopists must also keep abreast of the latest iteration of the Chicago classification version 4.0, which differs significantly from its predecessor in being more stringent in making diagnosis of esophagogastric junction outflow obstruction and disorders of peristalsis since these manometric findings may be seen in normal individuals and may be mimicked by opioid use and gastroesophageal reflux. The latest rendition also includes the use of provocative maneuvers and testing in both supine and sitting posture. Despite being the gold standard, there are certain lacunae in the use and interpretation of the Chicago classification of which the users should be well aware. Emerging technologies such as functional lumen imaging probe and planimetry, and timed barium esophagogram fill the lacuna in diagnosis of these motility disorders, which at times is beyond the resolution of HRM. [ABSTRACT FROM AUTHOR]

Background and Aim: As there is a scarcity of data on overall prevalence, risk factors, and health‐care utilization of esophageal symptoms using the Rome criteria in the rural population in Asia, we undertook a study with the aims to evaluate: (i) the prevalence of heartburn, chest pain, globus, and dysphagia of presumed esophageal origin; (ii) the prevalence of functional esophageal disorders by Rome III criteria; (iii) the risk factors for esophageal symptoms; and (iv) the health‐care utilization. Methods: This door‐to‐door survey was conducted in three villages (Charcharia, Churain of Dhaka district, and Kharrah of Munshiganj district of Bangladesh) among the adult population (≥18 years) using the translated and validated Enhanced Asian Rome III questionnaire. Results: Of 3559 individuals, 3351 (94.15%) responded (mean age 40.41 ± 16.04 years, female, 1924 [57.4%]). Heartburn was the most common symptom, 863 (25.8%), followed by chest pain, 367 (11%); globus, 285 (8.5%); and dysphagia, 146 (4.4%). At least one symptom was present in 1108 (33.1%) respondents. Based on Rome III criteria, 428 (12.8%), 41 (1.2%), 49 (1.5%), 26 (0.8%), and 524 (15.6%) had heartburn, chest pain, globus, dysphagia, and at least one functional esophageal disorder, respectively. Female gender, lower family income, presence of functional dyspepsia‐irritable bowel syndrome (FD‐IBS) overlap, FD only, and psychological distress were found to be risk factors for esophageal symptoms on multivariate analysis. Among the subjects with any esophageal disorders, 156 (14.1%) consulted any health‐care provider, and 517 (46.6%) took antisecretory medications. Conclusion: Esophageal symptoms are common in the rural community of Bangladesh and are associated with substantial health resource utilization. [ABSTRACT FROM AUTHOR]

OBJECTIVES:We aimed at evaluating the role of interleukin-1B (IL-1B) and IL-1RN polymorphisms, which may modulate the gastric mucosal expression of IL-1β, thus altering acid secretion, which influences the severity of gastroesphageal reflux disease (GERD).METHODS:In a prospective study, 144 patients with GERD (diagnosed by at least two of these criteria: Carlsson–Dent score of 6, endoscopic evidence of GERD, histopathological evidence of esophagitis, percentage time esophageal pH <4 for >5% on 24-h pH monitoring, and response to omeprazole 20 mg/day) and 368 healthy controls were genotyped for IL-1B−511 C/T and IL-1RN VNTR polymorphism (by PCR–restriction fragment length polymorphism (RFLP) and PCR, respectively). Gastric mucosal IL-1β levels (picogram/milligram of biopsy sample) were measured (using enzyme-linked immunosorbent assay (ELISA)) in 71 patients. Helicobacter pylori diagnosis was conducted using anti–H. pylori immunoglobulin G (IgG) ELISA.RESULTS:Patients (41.1±13.3 years old, 96 (66.7%) men) were comparable with healthy controls (43.4±11.8 years old, 238 (64.7%) men) with respect to age and gender. The IL-1B–511 CC genotype and C allele were associated with higher risk of GERD than the TT genotype (P=0.01, odds ratio (OR)=2.0, 95% confidence interval (CI)=1.12–3.57) and the T allele (P=0.04, OR=1.3, 95% CI=1.0–1.7), respectively. TT and C noncarriers had more IL-1β than CT (33.2 (2.6–161.3) vs. 16.7 (2.8–121.9), P=0.04) and C carriers (33.2 (2.6–161.3) vs. 15.16 (1.5–121.9), P=0.04), respectively. IL-1RN “1,2” and “2 carriers” had higher risk (P<0.001, OR=2.0, 95% CI=1.31–3.1; P=0.01, OR=1.6, 95% CI=1.1–2.4, respectively). “2,2” Had lower IL-1β levels than both “1,1” and “1,2” (9.2 (1.5–70.7) vs. 26.8 (5.7–161.3), P=0.006; 9.2 (1.5–70.7) vs. 24.4 (2.6–78.0), P=0.02). However, “2 carriers” tended to have lower IL-1β levels than “2 noncarriers” (21.7 (1.5–78.0) vs. 26.8 (5.7–161.3), P=0.09). The IL-1B−511*T/IL-1RN*1 (“T1”) haplotype showed lower risk (P=0.05, OR=0.7, 95% CI=0.5–1.0). “T1” had higher IL-1β levels than both “T1 carriers” and “T1 noncarriers” (43.5 (18.2–161.3) vs. 23.9 (2.6–121.9), P=0.02; 43.5 (18.2–161.3) vs. 10.9 (1.5–82.6), P=0.06, respectively). The presence of H. pylori infection was associated with the stronger risk of the IL-1B−511*CC genotype. The “T1” haplotype was strongly protective against GERD among patients with H. pylori infection.CONCLUSIONS:The T1 haplotype was associated with the reduced risk of GERD, particularly among patients with H. pylori infection, probably because of higher gastric mucosal IL-1β levels. [ABSTRACT FROM AUTHOR]