Influence ofHelicobacterpylori, sex, and age on serum gastrin and pepsinogen concentrations in subjects

The relation between Helicobacter pylori (H pylori) infection and fasting gastrin and pepsinogen-I and -II concentrations was evaluated in 278 volunteers without symptoms and the results were compared with the values obtained in 35 patients with duodenal ulcers. H pylori infection was determined with the 13C-urea breath test in subjects without symptoms and with endoscopy, biopsy (histology and culture), and quick urease test (CLO-test) in patients with duodenal ulcers. Gastrin and pepsinogen-I and -II concentrations were assayed with specific radioimmunoassay systems. The results clearly indicate that fasting gastrin and pepsinogen-I and -II concentrations were significantly higher in H pylori positive compared withH pylori negative subjects. Neither age nor sex affected basal gastrin and pepsinogen concentrations in H pylori negative subjects. Fasting gastrin, pepsinogen-I and -II concentrations in serum samples were similar in H pylori positive persons with no symptoms and those with duodenal ulcers suggesting that similar mechanisms are involved in increasing plasma concentrations ofthese variables in both populations. Hypergastrinaemia and hyperpepsinogenaemia are therefore probably secondary to activeH pylori infection. (Gut 1993; 34: 752-756) Division of Gastroenterology and Department of Research, University Hospital, CH-4031 Basel, Switzerland S Mossi B Meyer-Wyss G Gamboni C Beglinger Division of Gastroenterology, University Hospital, CH-3010 Berne, Switzerland E L Renner H S Merki Correspondence to: Dr C Beglinger, Division of Gastroenterology, University Hospital, CH-4031 Basel, Switzerland. Accepted for publication 6 October 1992 Colonisation of the gastric mucosa by Helicobacter pyloni (H pylori) is associated with chronic gastritis and peptic ulcer disease, but the role of H pylori in the pathogenesis of peptic ulcer disease is still unclear.' Thus although eradication of H pylori has been shown to dramatically reduce ulcer relapse rates,2 3 we still do not know how H pylori causes ulcers. Besides H pylori, aggressive factors (acid, pepsin) are necessary for peptic ulcer pathogenesis. Measurement of serum gastrin and pepsinogen concentrations is considered a diagnostic tool to indirectly assess these factors.4 Information on the interrelations between H pylori, chronic gastritis, and circulating gastrin or pepsinogen concentrations seems, however, confusing" and in particular, there is no consensus on how the mechanisms interact. Recently, it has been suggested that in humans gastric acid and serum pepsinogen secretion rates increase with age as does the prevalence of H pylori infection. 6 Although H pyloni infection was associated with decreased acid secretion rates in the few subjects studied, serum gastrin concentrations surprisingly did not differ between H pylori positive and H pylon negative subjects.6 The aim of this study was therefore to further explore the potential relation between serum gastrin and pepsinogen-I and -II concentrations and H pylon infection in a large number of H pylori positive and H pylori negative, subjects without symptoms and to compare the results with those in patients with duodenal ulcers. We also aimed to re-evaluate the effects of age and sex on these variables.