Skip to main content
SpringerLink
Log in

Gastric Acid Normosecretion Is Not Essential in the Pathogenesis of Mild Erosive Gastroesophageal Reflux Disease in Relation to Helicobacter pylori Status

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

In the pathogenesis of gastroesophageal reflux disease (GERD), gastric acid is considered to be one of the most important factors, but little is known about the degree of gastric acid secretion in GERD patients. In this study, we evaluated it in GERD patients and control subjects by 24-h intragastric pH, and serological and histological investigations, in relation to Helicobacter pylori (H. pylori) status. In H. pylori-negative GERD patients gastric acid secretion was similar to that in H. pylori-negative control subjects. In H. pylori-positive GERD patients, in particular, mild GERD patients, it decreased significantly compared to that in H. pylori-negative control subjects, but the degree of decrease was smaller than in H. pylori-positive control subjects. Results of serological and histological evaluation were supportive. In conclusion, in some GERD patients, gastric acid secretion was significantly decreased. Increased or maintained gastric acid secretion was not essential in the pathogenesis of mild GERD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Asaka M, Kimura T, Kudo M, Takeda H, Mitani S, Miyazaki T, Miki K, Graham DY: Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. Gastroenterology 102:760–766, 1992

    Google Scholar 

  2. Replogle ML, Kasumi W, Ishikawa KB, Yang SF, Juji T, Miki K, Kabat GC, Parsonnet J: Increased risk of Helicobacter pylori associated with birth in wartime and post-war Japan. Int J Epidemiol 25:210–214, 1996

    Google Scholar 

  3. Fujimoto K, Okamoto K, Iwakiri R: Epidemiology of gastroesophageal reflux disease. Nippon Naika Gakkai Zasshi 89:9–13, 2000 (in Japanese)

    Google Scholar 

  4. Takayasu H, Miwa T: Epidemiology of gastro-esophageal reflux disease. Nippon Rinsho 58:1886–1891, 2000 (in Japanese)

    Google Scholar 

  5. Dent J, Holloway RH, Toouli J, Dodds WJ: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut 29:1020–1028, 1988

    Google Scholar 

  6. Tytgat GN, Janssens J, Reynolds JC, Wienbeck M: Update on the pathophysiology and management of gastro-oesophageal reflux disease: the role of prokinetic therapy. Eur J Gastroenterol Hepatol 8:603–611, 1996

    Google Scholar 

  7. Stanciu C, Bennett JR: Oesophageal acid clearing: one factor in the production of reflux oesophagitis. Gut 15:852–857, 1974

    Google Scholar 

  8. Orlando RC: Pathophysiology of gastroesophageal reflux. Oesophageal epithelial resistance. In The Oesophagus. DOCastell (ed). New York, Little, Brown, 1992, pp 463–478

    Google Scholar 

  9. Safaie-Shirazi S, DenBesten L, Zike WL: Effect of bile salts on the ionic permeability of the esophageal mucosa and their role in the production of esophagitis. Gastroenterology 68:728–733, 1975

    Google Scholar 

  10. Jankowski J, Coghill G, Tregaskis B, Hopwood D, Wormsley KG: Epidermal growth factor in the oesophagus. Gut 33:1448–1453, 1992

    Google Scholar 

  11. Orlando RC, Bryson JC, Powell DW: Mechanisms of HC injury in rabbit esophageal epithelium. Am J Physiol 246:G718–G724, 1984

    Google Scholar 

  12. Cunningham KM, Horowitz M, Riddell PS, Maddern GJ, Myers JC, Holloway RH, Wishart JM, Jamieson GG: Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease. Gut 32:1436–1440, 1991

    Google Scholar 

  13. Zhu H, Pace F, Sangaletti O, Bianchi Porro G: Gastric acid secretion and pattern of gastroesophageal reflux in patients with esophagitis and concomitant duodenal ulcer. A multivariate analysis of pathogenetic factors. Scand J Gastroenterol 28:387–392, 1993

    Google Scholar 

  14. Collen MJ, Johnson DA, Sheridan MJ: Basal acid output and gastric acid hypersecretion in gastroesophageal reflux disease. Correlation with ranitidine therapy. Dig Dis Sci 39:410–717, 1994

    Google Scholar 

  15. Collen MJ, Lewis JH, Benjamin SB: Gastric acid hypersecretion in refractory gastroesophageal reflux disease. Gastroenterology 98:54–61, 1994

    Google Scholar 

  16. Cadiot G, Bruhat A, Rigaud D, Coste T, Vuagnat A, Benyedder Y, Vallot T, Le Guludec D, Mignon M: Multivariate analysis of pathophysiological factors in reflux oesophagitis. Gut 40:167–174, 1997

    Google Scholar 

  17. Hirschowitz BI: A clitical analysis, with appropriate controls, of gastric acid and pepsin secretion in clinical esophagitis. Gastroenterology 101:1149–1158, 1991

    Google Scholar 

  18. Kimura K, TakemotoT: Endoscopic atrophy border. Endoscopy 1:1–3, 1969

    Google Scholar 

  19. Satoh K, Kimura K, Taniguchi Y, Yoshida Y, Kihira K, Takimoto T, Kawata H, Saifuku K, Ido K, Takemoto T, Ota Y, Tada M, Karita M, Sakaki N, Hoshihara Y: Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and-negative patients with chronic gastritis. Am J Gastroenterol 91:963–969, 1996

    Google Scholar 

  20. Ito S, Azuma T, Murakita H, Hirai M, Miyaji H, Ito Y, Ohtaki Y, Yamazaki Y, Kuriyama M, Keida Y, Kohli Y: Profile of Helicobacter pylori cytotoxin derived from two areas of Japan with different prevalence of atrophic gastritis. Gut 39:800–806, 1996

    Google Scholar 

  21. Dixon MF, Genta RM, Yardley JH, Correa P: Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 20:1161–1181, 1996

    Google Scholar 

  22. Miki K, Ichinose M, Shimizu A, Huang SC, Oka H, Furihata C, Matsushima T, Takahashi K: Serum pepsinogens as a screening test of extensive chronic gastritis. Gastroenterol Jpn 22:133–141, 1987

    Google Scholar 

  23. Levi S, Beardshall K, Haddad G, Playford R, Ghosh P, Calam J: Campylobacter pylori and duodenal ulcers: the gastrin link. Lancet 27:1167–1168, 1989

    Google Scholar 

  24. Calam J: The somatostatin-gastrin link of Helicobacter pylori infection. Ann Med 27:569–573, 1995

    Google Scholar 

  25. Konturek PC, Konturek SJ: Role of Helicobacter pylori infection in gastroduodenal secretion and in pathogenesis of peptic ulcer and gastritis. J Physiol Pharmacol 45:333–350, 1994

    Google Scholar 

  26. Calam J: Pathogenic mechanisms. Baillieres Clin Gastroenterol 9:487–506, 1995

    Google Scholar 

  27. Graham DY, Opekun A, Lew GM, Evans DJ Jr, Klein PD, Evans DG: Ablation of exaggerated meal-stimulated gastrin release in duodenal ulcer patients after clearance of Helicobacter (Campylobacter) pylori infection. Am J Gastroenterol 85:394–398, 1990

    Google Scholar 

  28. El-Omar E, Penman I, Dorrian CA, Ardill JE, McColl KE: Eradicating Helicobacter pylori infection lowers gastrin mediated acid secretion by two thirds in patients with duodenal ulcer. Gut 34:1060–1065, 1994

    Google Scholar 

  29. Levi S, Beardshall K, Swift I, Foulkes W, Playford R, Ghosh P, Calam J: Antral Helicobacter pylori, hypergastrinaemia, and duodenal ulcers: effect of eradicating the organism. BMJ 299:1504–1505, 1989

    Google Scholar 

  30. Courillon-Mallet A, Launay JM, Roucayrol AM, Callebert J, Emond JP, Tabuteau F, Cattan D: Helicobacter pylori infection: Physiopathologic implications of N-?-methyl histamine. Gastroenterology 108:95–966, 1995

    Google Scholar 

  31. Noach LA, Bosma NB, Jansen J, Hoek FJ, van Deventer SJ, Tytgat GN: Mucosal tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-8 production in patients with Helicobacter pylori infection. Scand J Gastroenterol 29:425–429, 1994

    Google Scholar 

  32. Crabtree JE, Shallcross TM, Heatley RV, Wyatt JI: Mucosal tumour necrosis factor alpha and interleukin-6 in patients with Helicobacter pylori associated gastritis. Gut 32:1473–1477, 1991

    Google Scholar 

  33. Nompleggi DJ, Beinborn M, Roy A, Wolfe MM: The effect of recombinant cytokines on [14C]-aminopyrine accumulation by isolated canine parietal cells. J Pharmacol Exp Ther 270:440–445, 1994

    Google Scholar 

  34. Kondo S, Shinomura Y, Kanayama S, Kawabata S, Miyazaki Y, Imamura I, Fukui H, MatsuzawaY: Interleukin-1 beta inhibits gastric histamine secretion and synthesis in the rat. AmJ Physiol 267:G966–G971, 1994

    Google Scholar 

  35. Feldman M, Cryer B, McArthur KE, Huet BA, Lee E: Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology 110:1043–1052, 1996

    Google Scholar 

  36. Hurwitz A, Brady DA, Schaal SE, Samloff IM, Dedon J, Ruhl CE: Gastric acidity in older adults. JAMA 278:659–662, 1997

    Google Scholar 

  37. Trey G, Marks IN, Louw JA, Jaskiewicz K, Sipponen P, Novis BH, Bank S, Tigler-Wybrandi NA: Changes in acid secretion over the years. A 30-year longitudinal study. J Clin Gastroenterol 25:499–502, 1997

    Google Scholar 

  38. Haruma K, Kamada T, Kawaguchi H, Okamoto S, Yoshihara M, Sumii K, Inoue M, Kishimoto S, Kajiyama G, Miyoshi A: Effect of age and Helicobacter pylori infection on gastric acid secretion. J Gastroenterol Hepatol 15:277–283, 2000

    Google Scholar 

  39. Ohara S, Sekine H, lijima K, Moriyama S, Nakayama Y, Kinpara T, Kato K, Asaki S, Katakura T, Ikeda T, Toyota T: Gastric mucosal atrophy and prevalence of Helicobacter pylori in reflux esophagitis of the elderly. Nippon Shokakibyo Gakkai Zasshi 93:235–239, 1996 (in Japanese with English abstract)

    Google Scholar 

  40. Goedhard JG, Biemond I, Giliams JP, Pals G, Kreuning J: Serum pepsinogen I levels: assessment of gastric acid secretion? Prog Clin Biol Res 173:139–146, 1985

    Google Scholar 

  41. YamajiY, Mitsushima T, Ikuma H, Okamoto M, Yoshida H, Kawabe T, Shiratori Y, Saito K, Yokouchi K, Omata M: Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oesophagitis compared with gastric cancer: analysis of 5732 Japanese subjects. Gut 49:335–340, 2001

    Google Scholar 

  42. Manes G, Mosca S, Laccetti M, Lioniello M, Balzano A: Helicobacter pylori infection, pattern of gastritis, and symptoms in erosive and nonerosive gastroesophageal reflux disease. Scand J Gastroenterol 34:658–662, 1999

    Google Scholar 

  43. Voutilainen M, Sipponen P, Mecklin JP, Juhola M, Farkkila M: Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion 61:6–13, 2000

    Google Scholar 

  44. Haruma K, Hamada H, Mihara M, Kamada T, Yoshihara M, Sumii K, Kajiyama G, Kawanishi M: Negative association between Helicobacter pylori infection and reflux esophagitis in older patients: case-control study in Japan. Helicobacter 5:24–29, 2000

    Google Scholar 

  45. EI-Serag HB, Sonnenberg A, Jamal MM, Inadomi JM, Crooks LA, Feddersen RM: Corpus gastritis is protective against reflux oesophagitis. Gut 45:181–185, 1999

    Google Scholar 

  46. El-Omar EM, Carrington M, Chow WH, McColl KE, Bream JH, Young HA, Herrera J, Lissowska J, Yuan CC, Rothman N, Lanyon G, Martin M, Fraumeni JF Jr, Rabkin CS: Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature 404:398–402, 2000

    Google Scholar 

  47. Furuta T, El-Omar EM, Xiao F, Shirai N, Takashima M, Sugimura H, Sugimurra H: Interleukin 1 beta polymorphisms increase risk of hypochlorhydria and atrophic gastritis and reduce risk of duodenal ulcer recurrence in Japan. Gastroenterology 123:92–105, 2002

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Medicine, Hiroshima University Hospital, Hiroshima

    Tomohiko Shimatani & Susumu Tazuma

  2. Department of Community and Geriatric Nursing, Institute of Health Sciences, Hiroshima University School of Medicine, Hiroshima

    Masaki Inoue

  3. Department of Drug Information, Hiroshima Pharmaceutical and Public Health Center, Hiroshima

    Nobue Harada

  4. Department of Internal Medicine, Eastern Examination Center, Hiroshima

    Yoko Horikawa

  5. Department of Internal Medicine, Wakasagi Medical Clinic, Tokyo, Japan

    Masuo Nakamura

Authors
  1. Tomohiko Shimatani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaki Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nobue Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoko Horikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masuo Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susumu Tazuma
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimatani, T., Inoue, M., Harada, N. et al. Gastric Acid Normosecretion Is Not Essential in the Pathogenesis of Mild Erosive Gastroesophageal Reflux Disease in Relation to Helicobacter pylori Status. Dig Dis Sci 49, 787–794 (2004). https://doi.org/10.1023/B:DDAS.0000030090.84412.2a

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:DDAS.0000030090.84412.2a

Search

Navigation