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Letter
Hypergastrinaemia in patients infected with Helicobacter pylori treated with proton pump inhibitors
  1. H L Waldum
  1. Correspondence to:
    Professor H L Waldum
    Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Trondheim University, Trondheim N-7006, Norway; helge.waldummedisin.ntnu.no

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    We read with interest the commentary by McColl on Helicobacter pylori infection and long term proton pump inhibitor (PPI) therapy (Gut 2004;53:5–7).

    It is remarkable that he did not mention gastrin although hypergastrinaemia is a result of reduced gastric acidity1 as well as Helicobacter pylori infection,2 and that patients with H pylori infection treated with PPI have additive hypergastrinaemia.3 Hypergastrinaemia predisposes to gastric carcinoids in animals4,5 and humans6,7 as well as to malignant ECL cell derived tumours (gastric carcinomas) in animals8 and humans.9,10

    Interestingly, the carcinogenic effect of H pylori infection may be completely explained by its hypergastrinaemic effect,11 a work where McColl was one of the authors. Furthermore, the increased gastric cancer frequency in moderate hypergastrinaemic INS-GAS mice concomitantly infected by H pylori infection12 may also be caused by increased hypergastrinaemia in infected mice.13

    To conclude, it is odd that gastrin was not taken into consideration when discussing the risk of gastric cancer following treatment with PPI in patients infected with H pylori. Animal as well as human studies linking gastrin to gastric cancer give support for a strategy where H pylori is eradicated in patients on long term PPI treatment.

    References

    1. ↵
      Korman MG, Strickland RG, Hansky J. Serum gastrin in chronic gastritis. BMJ1971;2:16–18.
    2. ↵
      Moss SF, Calam J. Acid secretion and sensitivity to gastrin in patients with duodenal lulcer: effect of eradication of Helicobacter pylori. Gut1993;34:888–92.
      OpenUrlAbstract/FREE Full Text
    3. ↵
      Schenk BE, Kuipers EJ, Klinkenberg-Knol EC, et al. Hypergastrinaemia during long-term omeprazole therapy: influences of vagal nerve function, gastric emptying and Helicobacter pylori infection. Aliment Pharmacol Ther1998;12:605–12.
      OpenUrlCrossRefPubMed
    4. ↵
      Havu N. Enterochromaffin-like cell carcinoids of gastric mucosa in rats after life-long inhibition of gastric acid secretion. Digestion1986;35 (suppl) :42–55.
    5. ↵
      Hirayama F, Takagi S, Iwao E, et al. Development of poorly differentiated adenocarcinoma and carcinoid due to long-term Helicobacter pylori colonization in Mongolian gerbils. J Gastroenterol1999;24:450–4.
    6. ↵
      Sjöblom S-M, Sipponen P, Karonen S-L, et al. Argyrophil cell hyperplasia and carcinoid tumours in oxyntic mucosa of the stomach. Dependence on duration of pernicious anaemia. Eur J Gastroenterol Hepatol1991;31:153–7.
      OpenUrl
    7. ↵
      Cadiot G, Vissuzaine C, Potet F, et al. Fundic argyrophic carcinoid tumor in a patient with sporadic-type Zollinger-Ellison syndrome. Dig Dis Sci1995;40:1275–8.
      OpenUrlPubMed
    8. ↵
      Waldum HL, Rørvik H, Falkmer S, et al. Neuroendocrine (ECL-cell) differentiation of spontaneous gastric carcinomas of cotton rats (Sigmodon hispidus). Lab Anim Sci1999;49:241–7.
      OpenUrlPubMedWeb of Science
    9. ↵
      Qvigstad G, Qvigstad T, Westre B, et al. Neuroendocrine differentiation in gastric adenocarcinomas associated with severe hypergastrinemia and/or pernicious anemia. APMIS2002;110:132–9.
      OpenUrlCrossRefPubMedWeb of Science
    10. ↵
      Qvigstad G, Falkmer S, Westre B, et al. Clinical and histopathological tumour progression in ECL cell carcinoids (“ECLomas”). APMIS1999;107:1085–93.
      OpenUrlPubMedWeb of Science
    11. ↵
      Hansen S, Vollset SE, Ardill JES, et al. Hypergastrinemia is a strong predictor of distal gastric adenocarcinoma among Helicobacter pylori infected persons. Gastroenterology1997;112:A575.
      OpenUrlCrossRefWeb of Science
    12. ↵
      Wang TC, Dangler CA, Chen D, et al. Synergistic interaction between hypergastrinemia and Helicobacter infection in a mouse model of gastrin carcinoma. Gastroenterology2000;118:36–47.
      OpenUrlCrossRefPubMedWeb of Science
    13. ↵
      Waldum HL, Brenna E, Martinsen TC. Safety of proton pump inhibitors. Aliment Pharmacol Ther2000;14:1537–8.
      OpenUrlCrossRefPubMed

    Footnotes

    • Conflict of interest: None declared.