Effect of age, Helicobacter pylori infection, and gastritis with atrophy on serum gastrin and gastric acid secretion in healthy men.

Abstract

Gastric acid secretion has been considered to decline with increasing age but this view is being re-evaluated as the importance of Helicobacter pylon infection emerges. This study aimed to determine the effect of age, H pylon, and gastritis with atrophy on the serum gastrin concentration, gastric secretory volumes, and acid output in healthy, asymptomatic men. Young men (mean (SD) age 22-9 (0.6) years; n=22) were compared with old men (72.9 (1-2) years; n=28) in respect of basal serum gastrin and basal, sham fed, pentagastrin stimulated maximal and peak acid secretion. Antral, corpus, and fundal biopsy specimens were taken for histology and H pylori status (histology, culture, and rapid urease test). H pylon associated gastritis was present in three of 22 young (13-6%) and 16 of 28 old (57.1%) men. Gastritis with atrophy was present in 11 old subjects, 10 of whom were H pylon positive. These subjects had higher mean (SD) serum gastrin concentrations than old subjects without atrophy and young subjects (61.8 (9.2); 40*0 (2.9); 36-8 (2.3) pmolll respectively; p<O0OOl). H pylon infected subjects had higher gastrin values than uninfected subjects, overall (55.3 (5.9); 36-0 (1-8) pmolll; p<00Ol) and in subjects without atrophy (45.3 (4.2); 36*0 (1.8) pmol/l; p<O003). In subjects without H pylon infection, gastrin values did not differ with age (old 37-1 (1.7); young (2-1) pmoMl). The maximal gastric secretory volume was lower in old subjects with atrophy. Acid output (mmol/h) in subjects with atrophy was lower than in subjects with no atrophy (basal: 3-0 (1 1); 5*1 (0 7); p=NS; sham fed: 5*4 (1.4); 9-3 (0.8); p<002; maximal: 18-9 (4.0); 31*4 (1.8); p<O002; peak: 25-1 (5.3); 43-4 (2.7); p<OO003). However, acid secretion in old subjects without atrophy was not different to that in young subjects, irrespective of H pylon status. These results did not differ when acid output was expressed as mmol/h/kg lean body mass or mmol/h/lkg fat free body weight. Using multiple linear regression analysis, gastritis with atrophy was the only factor that had an independent negative effect on acid secretion. In healthy men without atrophy, gastric acid secretion is preserved with ageing and is independent of H pylori status. Atrophy, which is closely related to Hpylon infection, is associated with a decline in acid secretion. Increased basal serum gastrin is related to both atrophy and H pylon infection but not to ageing per se.

Relationship between Helicobacter pylori, atrophic gastritis and gastric cancer

“…As such, gastric mucosal atrophy is not the normal result of ageing, but of a pathological process. 23 This was confirmed by cohort follow-up studies, which showed that atrophic gastritis virtually only occurred in subjects with chronic gastritis. 19,24 More recently, following the recognition of the clinical importance of H. pylori, it was confirmed that this organism is a major risk factor for the development of multifocal atrophic gastritis.…”

Gastric juice for the diagnosis of H pylori infection in patients on proton pump inhibitors

“…This is in keeping with a previous study [21] . H pylori infection associated atrophy and intestinal metaplasia progresses with age [22,23] . Thus, older patients may be more liable to have false-negative results from the commonly biopsied sites in our practice.…”

The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia

“…For every additional illness suffered, there was a 14% increase in relative risk of being at-risk of undernutrition (NHC score Z3). Gastrointestinal disease, malabsorption syndromes, acute and chronic infections, cancer, hypermetabolism (ie, hyperthyroidism), rheumatoid arthritis and many other diseases are associated with anorexia, micronutrient deficiencies and increasing energy requirement, and may result in an impaired nutritional status (Kerstetter et al, 1992;Katelaris et al, 1993;Roubenoff, 1993;Morley, 1997;Visvanathan, 2003).…”