Serum biomarkers for atrophic gastritis and antibodies against Helicobacter pylori in the elderly: Implications for vitamin B12, folic acid and iron status and response to oral vitamin therapy.
OBJECTIVE
To investigate the prevalence of serological markers for chronic atrophic gastritis (AG) and Helicobacter pylori antibodies (HPAb) in an elderly population, and to examine the interrelationship and significance for cobalamin, folic acid and iron status and response to oral vitamin therapy.


METHODS
The study included community-dwelling subjects (n=209), mean age 76 years, randomized to 4 month of oral daily treatment with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B(6) or placebo (double-blind). Biochemical tests were carried out before and after treatment.


RESULTS
AG, as indicated by a pepsinogen I/II ratio <2.9, occurred in 14% (26/190) and HPAb in 54% (102/190) of the subjects. AG subjects had higher levels of serum methylmalonic acid (MMA) (p<0.001), plasma homocysteine (tHcy) (p<0.05), lower haemoglobin (Hb) (p<0.01) and a higher prevalence of vitamin B(12) deficiency (p<0.01). HPAb was associated with AG, whereas AG subjects without HPAb had higher tHcy and MMA levels. There was no correlation between AG and iron status. Oral vitamin treatment led to greater (albeit non-significant) improvements in MMA, tHcy and total cobalamins in AG subjects compared to non-AG subjects.


CONCLUSIONS
AG is a common condition and is a significant determinant of vitamin B(12) status. AG is correlated to HPAB and lower Hb. Elderly AG subjects respond at least as well as non-AG subjects to oral treatment with B-vitamins in the doses employed.
Lewerin
Catharina
C
Departments of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden.
Jacobsson
Stefan
S
Lindstedt
Goran
G
Nilsson-Ehle
Herman
H
D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000276:immunology; D015415:Biomarkers / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005492:Folic Acid / Q000097:blood / Q000627:therapeutic use*; D005757:Gastritis, Atrophic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015577:Geriatric Assessment; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007501:Iron / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D012016:Reference Values; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000097:blood / Q000627:therapeutic use*; D025101:Vitamin B 6 / Q000627:therapeutic use*
D000907:Antibodies, Bacterial; D015415:Biomarkers; D025101:Vitamin B 6; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12