Gastric histology, serological markers and age as predictors of gastric acid secretion in patients infected with Helicobacter pylori.
BACKGROUND
Acid secretion is intimately associated with most upper gastrointestinal diseases. Helicobacter pylori infection is a major environmental factor modifying acid secretion.


OBJECTIVE
To study the association between the pattern of H pylori gastritis and gastric secretory function in a large number of subjects without specific upper gastrointestinal disease.


METHODS
Maximal acid output (MAO) was measured in 255 patients with dyspepsia showing normal endoscopy. Activity and severity of gastritis, atrophy and H pylori infection were assessed in body and antral biopsies. The correlations of histological parameters as well as age, sex, height, weight, smoking, serum gastrin, pepsinogen I and II, and their ratio with MAO were determined. Multiple linear regression was used to show the best possible predictors of MAO.


RESULTS
Negative relationships: Body atrophy and body-combined (active and chronic) inflammatory scores showed a potent inverse correlation with MAO (correlation coefficients (CC) 0.59 and 0.50, respectively). Body:antral chronic gastritis ratio and body:antral combined inflammation ratio (both with CC = 0.49) and age (CC = 0.44) were also inversely correlated with MAO. Intestinal metaplasia at both antral and body sites had negative relationships with acid output with CC = 0.23 and 0.20, respectively. Positive relationships: Serum pepsinogen I, body H pylori density:combined inflammation ratio and pepsinogen I:II ratio with CC of 0.38, 0.38 and 0.30, respectively, correlated with MAO. The H pylori density: combined inflammation of both antrum and body positively correlated with MAO (CC = 0.29 and 0.38, respectively). Male sex and patient height also positively correlated with acid output. Modelling showed that body combined inflammatory score, body atrophy, age and serum pepsinogen I are independent predictors of acid output (R(2) = 0.62).


CONCLUSIONS
Combination of body gastritis, body atrophy, age and serum pepsinogen I can be used as predictors of acid-secretory state in populations infected with H pylori.
Derakhshan
M H
MH
Department of Medicine and Therapeutics, Western Infirmary, University of Glasgow, Glasgow, UK.
El-Omar
E
E
Oien
K
K
Gillen
D
D
Fyfe
V
V
Crabtree
J E
JE
McColl
K E L
KE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000097:blood; D001426:Bacterial Proteins / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D005755:Gastrins / Q000097:blood; D005756:Gastritis / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D005757:Gastritis, Atrophic / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology
D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D015415:Biomarkers; D005755:Gastrins; C080866:cagA protein, Helicobacter pylori; C013550:gastrin 17; D020115:Pepsinogen C; D020116:Pepsinogen A