ORIGINAL ARTICLE

Gastric histology, serological markers and age as predictors of gastric acid secretion in patients infected with Helicobacter pylori

M H Derakhshan¹, E El-Omar¹, K Oien², D Gillen¹, V Fyfe¹, J E Crabtree³, K E L McColl¹

¹ Department of Medicine and Therapeutics, Western Infirmary, University of Glasgow, Glasgow, UK
² Department of Pathology, Western Infirmary, University of Glasgow, Glasgow, UK
³ Molecular Medicine Unit, St James’s University Hospital, Leeds, UK

Correspondence to:
Professor K E L McColl
Department of Medicine and Therapeutics, Western Infirmary, University of Glasgow, Glasgow G11 6NT, UK; k.e.l.mccoll{at}clinmed.gla.ac.uk

Background: Acid secretion is intimately associated with most upper gastrointestinal diseases. Helicobacter pylori infection is a major environmental factor modifying acid secretion.

Aim: 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 and materials: 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 (R² = 0.62).

Conclusion: 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.

Abbreviations: ANOVA, analysis of variance; BMI, body mass index; CagA, cytotoxin-associated gene A; CIS, combined inflammatory score; ECL, enterochromaffin-like; IQR, interquartile range; MAO, maximal acid output

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