Digestive Diseases and Sciences

, Volume 44, Issue 9, pp 1837–1842 | Cite as

Helicobacter pylori-Induced Gastritis May Contribute to Occurrence of Postprandial Symptomatic Hypoglycemia

  • Ozer Acbay
  • Aykut Ferhat Celik
  • Pinar Kadioglu
  • Suha Goksel
  • Sadi Gundogdu

Abstract

In our clinical experience, postprandialsymptomatic hypoglycemic (PSH) patients with H. pylorigastritis showed a substantial improvement in theirhypoglycemic symptoms after the eradication of H.pylori. Therefore, in this study we have investigatedwhether H. pylori gastritis may contribute to theoccurrence of PSH. For this purpose, we have evaluatedthe following parameters in 12 PSH patients with H. pylori gastritis before and one month afterthe eradication therapy: (1) the number and severity ofPSH attacks that occurred in a one-month period using a30-day diary, (2) the total symptom score following a mixed meal using a visual analog scalequestionnaire (VASQ), and (3) the glucose and insulinresponses to the mixed meal. After the eradication of H.pylori, the serum insulin responses at 30 and 60 min decreased (P < 0.001 in both), whereasthe plasma glucose levels at 150, 180 and 210 minincreased significantly (P < 0.001 for 180 min and P< 0.01 in others) following the mixed meal. The number and severity score of PSH attacks thatoccurred in a one-month period and the area under curvefor symptom score in VASQ decreased significantly (P< 0.001 in all). These results suggest that H. pylori gastritis may contribute to theoccurrence of PSH.

HELICOBACTER PYLORI POSTPRANDIAL HYPOGLYCEMIA INSULIN SECRETION GASTRIN 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Axelrod L, Levitsky LL: Hypoglycemia. InJoslin's Diabetes Mellitus. 13th ed. CR Kahn, GC Weir (eds). Philadelphia, Lea & Febiger, 1994, pp 976-999Google Scholar
  2. 2.
    Foster DW, Rubenstein AH: Hypoglycemia. InHarrison's Principles of Internal Medicine, 13th ed. KJ Isselbacker, E Braunwald, JD Wilson, JB Martin, A Fauci, DL Kasper (eds). New York, McGraw-Hill, 1994, pp 2000-2006Google Scholar
  3. 3.
    Luyckx AS, Lefebvre PJ: Plasma insulin in reactive hypoglycemia. Diabetes 20:435-442, 1971Google Scholar
  4. 4.
    Tamburrano G, Leonetti F, Sbracc?a P, Giaccari A, Locuratolo N, Lala A: Increased insulin sensitivity in patients with idiopathic reactive hypoglycemia. J Clin Endocrinol Metab 69:885-890, 1989Google Scholar
  5. 5.
    Foa PP, Dunbar JC, Klein SP, Levy SH, Malik MA, Campbell BB, Foa NL: Reactive hypoglycemia and A-cell ("pancreatic") glucagon deficiency in the adult. JAMA 244:2281-2285, 1980Google Scholar
  6. 6.
    Açbay Ö, Çelik AF, Gündo?du S: Does Helicobacter pylori-induced gastritis enhance food-stimulated insulin release? Dig Dis Sci 41:1327-1331, 1996Google Scholar
  7. 7.
    Connor H, Scarpello JHB. An insulinoma with reactive hypoglycemia. Postgrad Med J 55:735-738, 1979Google Scholar
  8. 8.
    Marshall BJ, Warren JR, Francis GJ, Langton SR, Goodwin CS, Blincow ED: Rapid urease test in the management of Campylobacter pyloridis-associated gastritis. Am J Gastroenterol 82:200-210, 1987Google Scholar
  9. 9.
    Price AB: The Sydney system: Histologic division. J Gastroenterol Hepatol 6:209-222, 1991Google Scholar
  10. 10.
    Laine L, Estrada R, Trujillo M, Fukanaga K, Neil G: Randomized comparison of differing periods of twice-a-day therapy for the eradication of Helicobacter pylori. Aliment Pharmacol Ther 10:1029-1033, 1996Google Scholar
  11. 11.
    Service FJ: Hypoglycemic disorders. N Engl J Med 332:1144-1152, 1995Google Scholar
  12. 12.
    Charles MA, Hofeldt F, Shackelford A, Waldeck N, Dodson LE, Bunker D Jr, Coggins JT, Eichner H: Comparison of oral glucose tolerance tests and mixed meals in patients with apparent idiopathic postabsorptive hypoglycemia: absence of hypoglycemia after mixed meals. Diabetes 30:465-470, 1981Google Scholar
  13. 13.
    Palardy J, Havrankova J, Lepage R, Matte R, Belanger R, D'Amour P, Ste-Marie LG: Blood glucose measurements during symptomatic episodes in patients with suspected postprandial hypoglycemia. N Engl J Med 321:1421-1425, 1989Google Scholar
  14. 14.
    Schwartz NS, Clutter WE, Shah SD, Cryer PE: Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest 79:777-781, 1987Google Scholar
  15. 15.
    Rowe JW, Young JB, Minaker KL, Stevens AL, Pallotta A, Landsberg L: Effect of insulin and glucose infusion on sympathetic nervous system activity in normal man. Diabetes 30:219-225, 1981Google Scholar
  16. 16.
    Lefebvre PJ, Scheen AJ: Hypoglycemia. InEllenberg & Rifkin's Diabetes Mellitus, 5th ed. D Porte, RS Sherwin (eds). New Jersey, Appleton & Lange, 1997, pp 1307-1328Google Scholar
  17. 17.
    Smith JT, Pounder RE, Nwokolo CU, Lanzon-Miller S, Evans DG, Graham DY, Evans DJ Jr: Inappropriate hypergastrinaemia in asymptomatic healthy subjects infected with Helicobacter pylori. Gut 31:522-525, 1990Google Scholar
  18. 18.
    Mossi S, Meyer-Wyss B, Renner EL, Merki HS, Gamboni G, Beglinger C: Influence of Helicobacter pylori, sex, and age on serum gastrin and pepsinogen concentrations in subjects without symptoms and patients with duodenal ulcers. Gut 34:752-756, 1993Google Scholar
  19. 19.
    Rehfeld JF, Stadil F: The effect of gastrin on basal and glucose-stimulated insulin secretion in man. J Clin Invest 52:1415-1426, 1973Google Scholar
  20. 20.
    Chiba T, Yamada T: Gut somatostatin. InGut Peptides: Biochemistry and Physiology. JH Walsh, GJ Dockray (eds). New York, Raven Press, 1994, pp 123-145Google Scholar
  21. 21.
    Gyr K, Beglinger C, Kohler E, Trantzl U, Keller U, Bloom SR: Circulating somatostatin: Physiological regulator of pancreatic function? J Clin Invest 79:1595-1600, 1987Google Scholar
  22. 22.
    Hansen L, Mineo H, Bisgaard T, Jorgensen PN, Holst JJ: Somatostatin is a major paracrine regulator of glucagon-like peptide-1 (GLP-1) secretion. Diabetologia 40(suppl 1):A128, 1997Google Scholar
  23. 23.
    Moss SF, Legon S, Bishop AE, Polak JM, Calam J: Effect of Helicobacter pylorion gastric somatostatin in duodenal ulcer disease. Lancet 340:930-932, 1992Google Scholar
  24. 24.
    Kaneko H, Nakada K, Mitsuma T, Uchida K, Furusawa A, Maeda Y, Morise K: Helicobacter pyloriinfection induces a decrease in immunoreactive-somatostatin concentrations of human stomach. Dig Dis Sci 37:409-416, 1992Google Scholar
  25. 25.
    Gotz JM, Veenendaal RA, Biemond I, Muller ES, Veselic M, Lamers CB: Serum gastrin and mucosal somatostatin in Helicobacter pylori-associated gastritis. Scand J Gastroenterol 30:1064-1068, 1995Google Scholar
  26. 26.
    Beales ILP, Calam J, Post L, Srinivasan S, Yamada T, Del Valle J: Effect of tumor necrosis factor-α and interleukin 8 on somatostatin release from canine fundic D cells. Gastroenterology 112:136-143, 1997Google Scholar
  27. 27.
    Schubert ML, Edwards NF, Makhlouf GM: Regulation of gastric somatostatin secretion in the mouse by luminal acidity: A local feedback mechanism. Gastroenterology 94:317-322, 1988Google Scholar
  28. 28.
    Domschke S, Domschke W, Rosch W, Konturek SJ, Sprugel W, Mitznegg P, Wunsch E, Demling L: Inhibition by somatostatin of secretin-stimulated pancreatic secretion in man: A study with pure pancreatic juice. Scand J Gastroenterol 12:59-63, 1977Google Scholar
  29. 29.
    Hanssen LE, Hanssen KF, Myren U: Inhibition of secretion release and pancreatic bicarbonate secretion by somatostatin infusion in man. Scand J Gastroenterol 12:391-394, 1977Google Scholar
  30. 30.
    Dominguez-Munoz JE, Glasbrenner B, Sauerbruch T, Malfertheiner P: Interdigestive pancreatic secretion and PP release are increased in asymptomatic subjects with Helicobacterinfection of the gastric mucosa. Digestion 56:279, 1995Google Scholar
  31. 31.
    Wegener M, Borsch G, Schaffstein J, Schultz-Flaake C, Mai U: Does gastric Campylobacter pyloricolonization cause delay of gastric emptying in non-ulcer dyspepsia? Am J Gastroenterol 38:737-740, 1988Google Scholar
  32. 32.
    Pieramico O, Didschuneit H, Malfertheiner P: Gastrointestinal motility in patients with non-ulcer dyspepsia: A role for Helicobacter pyloriinfection? Am J Gastroenterol 88:364-368, 1993Google Scholar
  33. 33.
    Maconi G, Lazzaroni M, Sangaletti O, Bargigga S, Vago L, Bianchi G: Effect of Helicobacter pylorieradication on gastric histology, serum gastrin and pepsinogen I levels, and gastric emptying in patients with gastric ulcer. Am J Gastroenterol 10:1844-1848, 1997Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Ozer Acbay
  • Aykut Ferhat Celik
  • Pinar Kadioglu
  • Suha Goksel
  • Sadi Gundogdu

There are no affiliations available

Personalised recommendations