HELICOBACTER-PYLORI INFECTION AND CHRONIC GASTRIC-ACID HYPOSECRETION

Background & Aims: We have identified a subgroup of Helicobacter pylor i-infected subjects with low or absent gastric acid output. The aim of this study was to document the morphological and functional abnormali ties in these subjects and to assess the effect of eradicating the inf ection. Methods: The 16 hypochlorhydric subjects (6 men) had a mean ag e of 55 years (range, 36-79 years). They underwent a C-14-urea breath test, H. pylori serology, fasting gastrin, gastric autoantibodies, gas troscopy with antral and body biopsies, and measurement of peak acid o utput to pentagastrin (PAO(PG)). Their histology was compared with tha t of age- and sex-matched duodenal ulcer and nonulcer dyspepsia patien ts (16 each). H. pylori infection was eradicated in the hypochlorhydri c subjects, and the investigations were repeated 6 months later. Resul ts: Compared with controls, the hypochlorhydric subjects had less dens e H. pylori colonization, body-predominant colonization and gastritis, and increased prevalence of body atrophy and intestinal metaplasia. M edian PAO(PG) before eradication in the hypochlorhydric subjects was 1 .1 mmol/h and increased to 12.6 mmol/h after eradication (P < 0.001), with no significant change in body atrophy or intestinal metaplasia. C onclusions: In some subjects, chronic H. pylori infection produces a b ody-predominant gastritis and profound suppression of gastric acid sec retion that is partially reversible with eradication therapy.