Helicobacter pylori, parietal cell antibodies and autoimmune gastropathy in type 1 diabetes mellitus.
BACKGROUND
Fifteen to 20% of type 1 diabetic patients exhibit parietal cell antibodies (PCA), which are associated with autoimmune gastritis, hypochlorhydria, iron deficiency and pernicious anaemia.


OBJECTIVE
To examine whether Helicobacter pylori infection could explain the high prevalence of PCA and autoimmune gastropathy in diabetes. If so, H. pylori eradication could prevent autoimmune gastritis.


METHODS
In 229 type 1 diabetics (M/F: 135/94; age: 41 +/- 12 years) PCA were measured. H. pylori infection was assessed by serology, urea breath test in all and by histology (updated Sydney system) in 88 subjects. Pentagastrin tests were performed in 42 patients.


RESULTS
Sixty-nine patients were PCA-positive. H. pylori infection was present in 72 patients and was negatively associated with HLA-DQA1*0103-B1*0603 (OR=0.12, P=0.015) and positively with DQA1*0501-B1*0201 (OR=1.9, P=0.032). PCA-positivity was linked to HLA-DQA1*0501-B1*0301 (OR=3.9, P=0.017). A link between H. pylori and PCA was observed when PCA-positivity was defined as a titre > or = 1/20 (OR=2.0, P=0.03), but not if > or =1/40 was the cut-off point. PCA-positivity, but not H. pylori infection, was associated with iron deficiency anaemia (OR=2.7, P=0.008), pernicious anaemia (OR= 33.5, P < 0.0001), hypochlorhydria (OR=12.1, P=0.0008) and autoimmune gastritis (OR=12.5, P < 0.0001).


CONCLUSIONS
The HLA-bound susceptibility of H. pylori and PCA differed. PCA-positivity but not ongoing H. pylori infection is associated with autoimmune gastritis. Low titres of PCA might reflect H. pylori infection rather than autoimmune gastropathy.
De Block
C E M
CE
Department of Endocrinology-Diabetology, University of Antwerp, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. cdeblock@uia.ua.ac.be
De Leeuw
I H
IH
Bogers
J J P M
JJ
Pelckmans
P A
PA
Ieven
M M
MM
Van Marck
E A E
EA
Van Hoof
V
V
Máday
E
E
Van Acker
K L
KL
Van Gaal
L F
LF
D000328:Adult; D000907:Antibodies, Bacterial / Q000276:immunology* / Q000302:isolation & purification; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005756:Gastritis / Q000150:complications* / Q000276:immunology / Q000473:pathology; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D008297:Male; D010295:Parietal Cells, Gastric / Q000276:immunology*; D010418:Pentagastrin
D000907:Antibodies, Bacterial; D010418:Pentagastrin