Multifocal atrophic gastritis: pathogenesis and therapeutic implications.
OBJECTIVE
This study, carried out on 51 patients with multifocal atrophic gastritis (MAG) and 92 age and sex-matched dyspeptic controls, was designed to examine both exocrine (gastric acid) and endocrine (gastrin) gastric secretion before and after therapeutic intervention including Helicobacter pylori eradication and vitamin C treatment.


METHODS
Fasting and gastrin-releasing peptide-induced gastric acid secretion, serum levels of gastrin and proinflammatory (IL-1beta, IL-8, TNF-alpha) as well as gastric mucosal gene expression of ornithine decarboxylase (ODC), cyclooxygenase 2 (COX-2) and growth factors (epidermal growth factor and transforming growth factor alpha) were determined before and after the eradication of Helicobacter pylori and therapy with large doses (1 g/d) of vitamin C for 3 months.


RESULTS
The H. pylori eradication, assessed by C-urea breath test, and vitamin C therapy failed to reverse the histological atrophy of the gastric mucosa but improved significantly the functional status of the atrophied mucosa, especially its exocrine and endocrine secretory activities, attenuated the expression of premalignant markers such as ODC and COX-2, raised the production of growth factors and diminished the release of proinflammatory cytokines.


CONCLUSIONS
These results indicate that MAG may be considered as an environmental disease of the gastric mucosa, whose functional status can be improved by the eradication of H. pylori combined with antioxidant therapy with large doses of vitamin C.
Second Department of Surgery, Jagiellonian University Medical College, Cracow, Poland.
Kazimierz
K
Rembiasz
Andrzej
A
Budzynski
Danuta
D
Karcz
Peter C
PC
Konturek
Stanislaw J
SJ
Konturek
Jerzy
J
Stachura
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D016022:Case-Control Studies; D051546:Cyclooxygenase 2 / Q000032:analysis; D016207:Cytokines / Q000097:blood; D004815:Epidermal Growth Factor / Q000032:analysis; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005753:Gastric Mucosa / Q000378:metabolism / Q000473:pathology; D005755:Gastrins / Q000378:metabolism; D005757:Gastritis, Atrophic / Q000188:drug therapy / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009955:Ornithine Decarboxylase / Q000032:analysis; D012333:RNA, Messenger / Q000032:analysis; D016211:Transforming Growth Factor alpha / Q000032:analysis
D000900:Anti-Bacterial Agents; D000975:Antioxidants; D016207:Cytokines; D005755:Gastrins; D012333:RNA, Messenger; D016211:Transforming Growth Factor alpha; D004815:Epidermal Growth Factor; D051546:Cyclooxygenase 2; D009955:Ornithine Decarboxylase; D001205:Ascorbic Acid