GASTRITIS IN THE ALCOHOLIC - RELATIONSHIP TO GASTRIC ALCOHOL METABOLISM AND HELICOBACTER-PYLORI

Chronic gastritis is common in the alcoholic. It is characterized by h istological inflammation of the gastric mucosa and is associated with variable symptomatology. its etiology is still the subject of debate. Recently, a new alcohol dehydrogenase isoenzyme, called sigma ADH, abs ent from the liver but predominant in the upper GI tract, has been ful ly characterized its gene cloned, and it appears to play a major role in gastric ethanol metabolism. Indeed, it has now been established, bo th in vivo in experimental animals and in vitro in cultured human gast ric cells, that alcohol is metabolized in the gastric mucosa, resultin g in the production of acetaldehyde, a toxic metabolite. In addition, Helicobacter pylori infection is common in the alcoholic, resulting in the breakdown of urea to ammonia, another toxic product. A number of studies carried out over the last 40 years revealed that antibiotic tr eatment eradicates ammonia production and results in histological and symptomatic improvement in the majority of patients with alcoholic gas tritis. Non-invasive tests for the detection of H. pylori are now avai lable which will facilitate the large scale studies needed to confirm whether, in H. pylori-positive patients, antibiotics should become rou tine treatment for alcoholic gastritis.