Digestive Diseases and Sciences

, Volume 40, Issue 1, pp 153–159 | Cite as

Helicobacter pylori infection

A reversible cause of hypergastrinemia and hyperchlorhydria which may mimic Zollinger-Ellison syndrome
  • David C. Metz
  • H. Christian Weber
  • Murray Orbuch
  • Doris B. Strader
  • Irina A. Lubensky
  • Robert T. Jensen
Case Report


The present report describes two patients with fasting hypergastrinemia, gastric acid hypersecretion, andHelicobacter pylori gastritis. Provocative testing for Zollinger-Ellison syndrome was negative and imaging studies did not demonstrate an intra-abdominal mass. Following eradication of theHelicobacter pylori infection, the fasting hypergastrinemia resolved in both patients and in one patient the gastric acid hypersecretion also resolved. The implications of this case on the differential diagnosis of Zollinger-Ellison syndrome are discussed.

Key words

gastric acid hypersecretion duodenal ulcer stomach gastrinoma Zollinger-Ellison syndrome 


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  1. 1.
    Maton PN, Dayal Y: Clinical implications of hypergastrinemia.In Peptic Ulcer Disease and Other Acid-Related Disorders. D Zakim, AJ Dannenberg (eds). Armonk, New York, Academic Research Associates, 1991, pp 213–246Google Scholar
  2. 2.
    Wolfe MM, Jensen RT: Zollinger-Ellison syndrome: Current concepts in diagnosis and management. N Engl J Med 317:1200–1209, 1987PubMedGoogle Scholar
  3. 3.
    Jensen RT, Gardner JD: Gastrinoma.In The Pancreas: Biology, Pathobiology and Diseases, 2nd ed. VLW Go, EP DiMagno JD Gardner, E Lebenthal, HA Reber, GA Scheele (eds). New York, Raven Press, 1993, pp 931–978Google Scholar
  4. 4.
    Jensen RT, Gardner JD, Raufman JP, Pandol SJ, Doppman JL, Collen MJ: Zollinger-Ellison syndrome: current concepts and management. Ann Intern Med 98:59–75, 1983PubMedGoogle Scholar
  5. 5.
    Frucht H, Howard JM, Slaff JI, Wank SA, McCarthy DM, Maton PN, Vinayek R, Gardner JD, Jensen RT: Secretin and calcium provocative tests in the Zollinger-Ellison syndrome: A prospective study. Ann Intern Med 111:713–722, 1989PubMedGoogle Scholar
  6. 6.
    Andersen DK: Current diagnosis and management of Zollinger-Ellison syndrome. Ann Surg 210:685–695, 1989PubMedGoogle Scholar
  7. 7.
    Jensen RT, Maton PN: Zollinger-Ellison syndrome.In The Stomach. S Gustavsson, D Kumar, DY Graham (eds). London, Churchill Livingstone, 1992, pp 341–374Google Scholar
  8. 8.
    Frucht H, Howard JM, Stark HA, McCarthy DM, Maton PN, Gardner JD, Jensen RT: Prospective study of the standard meal provocative test in Zollinger-Ellison syndrome. Am J Med 87:528–536, 1989PubMedGoogle Scholar
  9. 9.
    Jensen RT: Gastrinoma as a model for prolonged hypergastrinemia in man.In Gastrin. JH Walsh (ed). New York, Raven Press, 1993, pp 373–393Google Scholar
  10. 10.
    Isenberg JI, McQuaid KR, Laine L, Rubin W: Acid-peptic disorders.In Textbook of Gastroenterology. T Yamada, DH Alpers, C Owyang, DW Powell, FE Silverstein (eds). Philadelphia, JB Lippincott, 1991, pp 1241–1339Google Scholar
  11. 11.
    Levi S, Beardshall K, Haddad G, Playford R, Ghosh P, Calam J:Campylobacter pylori and duodenal ulcers: The gastrin link [see comments]. Lancet 1:1167–1168, 1989PubMedGoogle Scholar
  12. 12.
    Smith JT, Pounder RE, Nwokolo CU, Lanzon-Miller S, Evans DG, Graham DY, Evans DJ Jr: Inappropriate hypergastrinaemia in asymptomatic healthy subjects infected withHelicobacter pylori. Gut 31:522–525, 1990PubMedGoogle Scholar
  13. 13.
    Levi S, Beardshall K, Swift I, Foulkes W, Playford R, Ghosh P, Calam J: AntralHelicobacter pylori, hypergastrinaemia, and duodenal ulcers: Effect of eradicating the organism. BMJ 299:1504–1505, 1989PubMedGoogle Scholar
  14. 14.
    Sachs G, Hersey SF, Pounder RE, Prewett EF: Gastric secretion.In The Stomach. S Gustavsson, D Kumar, DY Graham (eds). New York, Churchill Livingstone, 1992, pp 41–79Google Scholar
  15. 15.
    Goldschmiedt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M: Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology 101:977–990, 1991PubMedGoogle Scholar
  16. 16.
    Ramsey EJ, Carey KV, Peterson WL, Jackson JJ, Murphy FK, Read NW, Taylor KB, Trier JS, Fordtran JS: Epidemic gastritis with hypochlorhydria. Gastroenterology 76:1449–1457, 1979PubMedGoogle Scholar
  17. 17.
    Gledhill T, Leicester RJ, Addis B, Lightfoot N, Barnard J, Viney N, Darkin D, Hunt RH: Epidemic hypochlorhydria. Br Med J (Clin Res Ed) 290:1383–1386, 1985Google Scholar
  18. 18.
    Morris A, Nicholson G: Ingestion ofCampylobacter pyloridis causes gastritis and raised fasting gastric pH. Am J Gastroenterol 82:192–199, 1987PubMedGoogle Scholar
  19. 19.
    Nakanishi T, Shinomura Y, Kanayama S, Matsuzawa Y: Eradication ofHelicobacter pylori normalizes serum gastrin concentration and antral gastrin cell number in a patient with primary gastrin cell hyperplasia. Am J Gastroenterol 88:440–442, 1993PubMedGoogle Scholar
  20. 20.
    Lam SK: Pathogenesis and pathophysiology of duodenal ulcer. Clin Gastroenterol 13:447–472, 1984PubMedGoogle Scholar
  21. 21.
    Blair AJ, Feldman M, Barnett C, Walsh JH, Richardson CT: Detailed comparison of basal and food-stimulated gastric acid secretion rates and serum gastrin concentrations in duodenal ulcer patients and normal subjects. J Clin Invest 79:582–587, 1987PubMedGoogle Scholar
  22. 22.
    Karttunen T, Niemelä S, Lehtola J, Heikkilä J, Mäentausta O, Räsänen O:Campylobacter-like organisms and gastritis: Histopathology, bile reflux, and gastric fluid composition. Scand J Gastroenterol 22:478–486, 1987PubMedGoogle Scholar
  23. 23.
    McColl KE, Fullarton GM, Chittajalu R, el Nujumi AM, MacDonald AM, Dahill SW, Hilditch TE: Plasma gastrin, daytime intragastric pH, and nocturnal acid output before and at 1 and 7 months after eradication ofHelicobacter pylori in duodenal ulcer subjects. Scand J Gastroenterol 26:339–346, 1991PubMedGoogle Scholar
  24. 24.
    Montbriand JR, Appelman HD, Cotner EK, Nostrant TT, Elta GH: Treatment ofCampylobacter pylori does not alter gastric acid secretion. Am J Gastroenterol 84:1513–1516, 1989PubMedGoogle Scholar
  25. 25.
    Christie DL, Ament ME: Gastric acid hypersecretion in children with duodenal ulcer. Gastroenterology 71:242–244, 1976PubMedGoogle Scholar
  26. 26.
    Aoyagi T, Summerskill WHJ: Gastric secretion with ulcerogenic islet cell tumor. Arch Intern Med 117:667–672, 1966PubMedGoogle Scholar
  27. 27.
    Feldman M: Gastric secretion.In Gastrointestinal Disease. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1983, pp 541–558Google Scholar
  28. 28.
    Pisegna JR, Norton JA, Slimak GG, Metz DC, Maton PN, Jensen RT: Effects of curative resection on gastric secretory function and antisecretory drug requirement in the Zollinger-Ellison syndrome. Gastroenterology 102(3):767–778, 1992PubMedGoogle Scholar
  29. 29.
    Raufman JP, Collins SM, Pandol SJ, Korman LY, Collen MJ, Cornelius MJ, Feld MK, McCarthy DM, Gardner JD, Jensen RT: Reliability of symptoms in assessing control of gastric acid secretion in patients with Zollinger-Ellison syndrome. Gastroenterology 84:108–113, 1983PubMedGoogle Scholar
  30. 30.
    Thom AK, Norton JA, Doppman JL, Chang R, Miller DL, Jensen RT: Prospective study of the use of intraarterial secretin injection and portal venous sampling to localize duodenal gastrinomas. Surgery 112(6):1002–1008, 1992PubMedGoogle Scholar
  31. 31.
    Taylor IL, Calam J, Rotter JI, Vailant C, Samloff IM, Cook A, Simkin E, Dockray GJ: Family studies of hypergastrinemic, hyperpepsinogenemic I duodenal ulcer. Ann Intern Med 95(4):421–425, 1981PubMedGoogle Scholar
  32. 32.
    Norton JA, Doppman JL, Collen MJ, Harmon JW, Maton PN, Gardner JD, Jensen RT: Prospective study of gastrinoma localization and resection in patients with Zollinger-Ellison syndrome. Ann Surg 204:468–479, 1986PubMedGoogle Scholar
  33. 33.
    Norton JA, Doppman JL, Jensen RT: Curative resection in Zollinger-Ellison syndrome: Results of a 10-year prospective study. Ann Surg 215(1):8–18, 1992PubMedGoogle Scholar
  34. 34.
    Mossi S, Meyer-Wyss B, Renner EL, Merki HS, Gamboni G, Beglinger C: Influence ofHelicobacter pylori, sex, and age on serum gastrin and pepsinogen concentrations in subjects without symptoms and patients with duodenal ulcers. Gut 34:752–756, 1993PubMedGoogle Scholar
  35. 35.
    Tytgat GNJ, Noach LA, Rauws EAJ:Helicobacter pylori infection and duodenal ulcer disease. Gastroenterol Clin North Am 22:127–139, 1993PubMedGoogle Scholar
  36. 36.
    Peterson WL:Helicobacter pylori and peptic ulcer disease. N Engl J Med 324:1043–1047, 1991PubMedGoogle Scholar
  37. 37.
    Saeed ZA, Evans DJ Jr, Evans DG, Cornelius MJ, Maton PN, Jensen RT, Graham DY:Helicobacter pylori and the Zollinger-Ellison syndrome. Dig Dis Sci 36(1):15–18, 1991PubMedGoogle Scholar
  38. 38.
    Fich A, Talley NJ, Shorter RG, Philips SF: Zollinger-Ellison syndrome. Relation toHelicobacter pylori-associated chronic gastritis and gastric acid secretion. Dig Dis Sci 36(1):10–14, 1991PubMedGoogle Scholar
  39. 39.
    Metz DC, Weber C, Orbuch M, Strader DB, Gibril F, Jensen RT:Helicobacter pylori (Hp) infection and acid output in Zollinger-Ellison syndrome (ZES): A prospective study. Gastroenterology 106:A138, 1994Google Scholar
  40. 40.
    Ellison EH, Wilson SD: The Zollinger-Ellison syndrome: Re-appraisal and evaluation of 260 registed cases. Ann Surg 160:512–530, 1964PubMedGoogle Scholar
  41. 41.
    Jensen RT, Doppman JL, Gardner JD: Gastrinoma.In The Exocrine Pancreas: Biology, Pathobiology and Disease. VLW Go, FA Brooks, EP DiMagno, JD Gardner, E Lebenthal, GA Scheele (eds). New York, Raven Press, 1986, pp 727–744Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • David C. Metz
    • 1
    • 2
  • H. Christian Weber
    • 1
    • 2
  • Murray Orbuch
    • 1
    • 2
  • Doris B. Strader
    • 1
    • 2
  • Irina A. Lubensky
    • 1
    • 2
  • Robert T. Jensen
    • 1
    • 2
  1. 1.From the Digestive Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesUSA
  2. 2.Laboratory of PathologyNational Cancer Institute, National Institutes of HealthBethesda

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