Eradicating Helicobacter pylori reduces hypergastrinaemia during long term omeprazole treatment

A El-Nujumi,^a C Williams,^a J E Ardill,^c K Oien,^b K E L McColl^a

^a University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, UK, ^b Department of Pathology, Western Infirmary, Glasgow, ^c Department of Medicine, Royal Victoria Infirmary, Belfast, UK

Correspondence to: Professor McColl.

Accepted for publication 5 September 1997

BackgroundBoth proton pump inhibitor drug treatment and Helicobacter pylori infection cause hypergastrinaemia in man.
AimsTo determine whether eradicating H pylori is a means of reducing hypergastrinaemia during subsequent proton pump inhibitor treatment.
MethodsPatients with H pylori were randomised to treatment with either anti-H pylori or symptomatic treatment. One month later, all received four weeks treatment with omeprazole 40 mg/day for one month followed by 20 mg/day for six months. Serum gastrin concentrations were measured before and following each treatment.
ResultsIn the patients randomised to anti-H pylori treatment, eradication of the infection lowered median fasting gastrin by 48% and meal stimulated gastrin by 46%. When gastrin concentrations one month following anti-H pylori/symptomatic treatment were used as baseline, omeprazole treatment produced a similar percentage increase in serum gastrin in the H pylori infected and H pylori eradicated patients. Consequently, in the patients in which H pylori was not eradicated, median fasting gastrin concentration was 38 ng/l (range 26-86) at initial presentation and increased to 64 ng/l (range 29-271) after seven months omeprazole, representing a median increase of 68% (p<0.005). In contrast, in the patients randomised to H pylori eradication, median fasting gastrin at initial presentation was 54 ng/l (range 17-226) and was unchanged after seven months omeprazole at 38 ng/l (range 17-95).
ConclusionEradicating H pylori is a means of reducing the rise in gastrin during subsequent long term omeprazole treatment. In view of the potential deleterious effects of hypergastrinaemia it may be appropriate to render patients H pylori negative prior to commencing long term proton pump inhibitor treatment.
(GUT 1998;42:159-165)

Keywords: hypergastrinaemia;  Helicobacter pylori;  omeprazole