Eradication of Helicobacter pylori restores the inhibitory effect of cholecystokinin on gastric motility in duodenal ulcer patients.
BACKGROUND
Increased gastric emptying and defective action of endogenous cholecystokinin (CCK), that is known to inhibit this emptying, have been implicated in the pathogenesis of duodenal ulcer (DU). The aim of this double blind study was to assess whether CCK and somatostatin participate in the impairment of gastric motility in active DU patients before and after Helicobacter pylori eradication.


METHODS
Tests were undertaken in 10 DU patients without or with elimination of the action of endogenous CCK using loxiglumide, a selective CCK-A receptor antagonist, before and 4 weeks after eradication of H. pylori with 1 week triple therapy that resulted in healing of all DUs tested. The gastric emptying rate after feeding was determined using the 13C-acetate breath test. Before each test, samples of gastric juice were obtained by aspiration using a nasogastric tube for determination of somatostatin using specific radioimmunoassay.


RESULTS
Prior to H. pylori eradication gastric emptying half-time was 31 +/- 6 min in placebo-treated DU patients and this emptying rate was not significantly affected in tests after pretreatment with loxiglumide (10 mg/kg i.v.). Following eradication of H. pylori, in tests with placebo gastric emptying half-time was significantly longer (48 +/- 9 min) compared to that prior to H. pylori eradication. Pretreatment with loxiglumide in H. pylori eradicated DU patients significantly enhanced the gastric emptying rate with an emptying half-time of only 33 +/- 4 min. Eradication of H. pylori resulted in a significant increase in somatostatin concentration in gastric juice and loxiglumide significantly reduced this luminal somatostatin in H. pylori-eradicated subjects compared to values before anti-H. pylori therapy.


CONCLUSIONS
1) H. pylori infection in DU patients is accompanied by enhanced gastric emptying and reduction in luminal release of somatostatin; 2) the failure of loxiglumide to affect gastric emptying in H. pylori-infected DU patients might be attributed, at least in part, to the failure of endogenous CCK to control gastric motility due to deficient release of somatostatin; and 3) H. pylori-infected patients appear to exhibit a deficient somatostatin release by endogenous CCK that can be reversed by the eradication of H. pylori indicating that both CCK and somatostatin may contribute to normalization of gastric emptying following H. pylori eradication in DU patients.
Konturek
J W
JW
Dept. of Medicine B, University of Münster, Germany. jan.konturek@uni-muenster.de
Stoll
R
R
Menzel
J
J
Konturek
M
M
Konturek
S J
SJ
Domschke
W
W
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002766:Cholecystokinin / Q000187:drug effects / Q000378:metabolism*; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology*; D005753:Gastric Mucosa; D005755:Gastrins / Q000097:blood; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006727:Hormone Antagonists / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D019518:Postprandial Period; D011336:Probability; D011377:Proglumide / Q000008:administration & dosage* / Q000031:analogs & derivatives; D012016:Reference Values; D012680:Sensitivity and Specificity; D013004:Somatostatin / Q000032:analysis / Q000187:drug effects; D013392:Sucralfate / Q000008:administration & dosage; D016896:Treatment Outcome
D005755:Gastrins; D006727:Hormone Antagonists; D013004:Somatostatin; D013392:Sucralfate; C053737:loxiglumide; D002766:Cholecystokinin; D011377:Proglumide