Biphasic effects of H. pylori infection on low-dose aspirin-induced gastropathy depending on the gastric acid secretion level

Background The association of Helicobacter pylori infection with aspirin-induced gastropathy is controversial. H. pylori infection exerts diverse effects on gastric acid secretion. In this study, the interaction between H. pylori infection and aspirin was investigated with reference to the individua...

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Bibliographic Details
Published in:Journal of gastroenterology 2012-12, Vol.47 (12), p.1290-1297
Main Authors: Iijima, Katsunori, Ara, Nobuyuki, Abe, Yasuhiko, Koike, Tomoyuki, Iwabuchi, Toshimitsu, Shinkai, Hirohiko, Uno, Kaname, Endo, Hiroyuki, Asano, Naoki, Shimosegawa, Tooru
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Analysis
Aspirin
Aspirin - administration & dosage
Aspirin - adverse effects
Colorectal Surgery
Dosage and administration
Drug Administration Schedule
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Gastric Acid - secretion
Gastrin
Gastroenterology
Helicobacter infections
Helicobacter Infections - complications
Helicobacter Infections - metabolism
Helicobacter pylori
Helicobacter pylori - isolation & purification
Hepatology
Humans
Immunoglobulin G
Infection
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Original Article—Alimentary Tract
Pentagastrin
Platelet Aggregation Inhibitors - administration & dosage
Platelet Aggregation Inhibitors - adverse effects
Prospective Studies
Stomach Diseases - chemically induced
Stomach Diseases - metabolism
Stomach Diseases - microbiology
Surgical Oncology
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Summary:Background The association of Helicobacter pylori infection with aspirin-induced gastropathy is controversial. H. pylori infection exerts diverse effects on gastric acid secretion. In this study, the interaction between H. pylori infection and aspirin was investigated with reference to the individual gastric acid secretion level in H. pylori -positive subjects. Methods Ninety-three (81 men, mean age: 70 years) long-term low-dose aspirin takers were prospectively enrolled. H. pylori infection was evaluated by serum IgG antibody determination, and gastrin-stimulated acid output was assessed with the endoscopic gastrin test. H. pylori -positive aspirin-takers were classified into 2 subgroups (hyposecretors and non-hyposecretors). The grade of gastric mucosal injury was assessed endoscopically according to the modified Lanza score; intensive aspirin-induced gastropathy was defined as a modified Lanza score of ≥4. Multiple logistic regression analyses were used to adjust for potential confounders. Results With H. pylori -negative patients taken as the reference, H. pylori infection was found to be positively associated with intensive gastropathy among non-hyposecretors, with an odds ratio (OR) (95 % confidence interval [CI]) of 4.2 (1.1–17.1), while the infection was negatively associated with gastropathy among hyposecretors, with an OR (95 % CI) of 0.3 (0.08–0.9). Aspirin-induced gastropathy occurred preferentially in the antrum among H. pylori -positive non-hyposecretors, while it affected the fundus among H. pylori -positive hyposecretors. Conclusion The effect of H. pylori infection on the aspirin-induced gastropathy was biphasic depending on the individual gastric acid secretion level. In the presence of sufficient amounts of gastric acid, H. pylori infection and aspirin could synergistically damage gastric mucosal integrity, while in the absence of sufficient amounts of gastric acid, the synergistic effect could be completely counteracted and the infection could even suppress the aspirin-induced gastropathy.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-012-0598-8