• Adenocarcinoma
• Helicobacter pylori
• proton pump inhibition

The association between chronic active gastritis and pre-neoplastic conditions as well as invasive cancer of the stomach was established several decades ago. The risk of progression depended on the severity and distribution of gastritis, with cancer, in particular, occurring in subjects with pan-gastritis. Subsequently, Helicobacter pylori was recognised as the primary cause of chronic active gastritis, and it was demonstrated that the pattern of gastritis corresponded with the colonisation pattern of H pylori. We and others then showed both in animals and in humans that this pattern of colonisation and associated gastritis primarily depended on the level of acid output.1 2 Although this hypothesis was widely accepted, it led to intense debate when dealing with the safety of long-term treatment with profound acid suppressors. An elegant, long-awaited study from Japan published in this issue of Gut (see page 624) provides compelling evidence that the pattern of H pylori colonisation depends on acid output and that this influences the long-term progression to neoplasia.3

The current study was based on experiments in gerbils, one of the well-established animal models for the study gastric disease induced by Helicobacter spp.4 Gerbils, used sparingly for biomedical research, were first reported as a model for experimental H pylori infection in 1991.5 Interestingly, the gerbil has been shown …