Associations among Gastric Juice pH, Atrophic Gastritis, Intestinal Metaplasia and Helicobacter pylori Infection

Abstract

Background/aims: Gastric juice plays a crucial role in the physiology of the stomach. The aim of this study is to evaluate associations among the pH of gastric juice, atrophic gastritis (AG), intestinal metaplasia (IM), pepsinogen, and Helicobacter pylori infection.

Methods: Gastric biopsies and juice were collected from 46 subjects who underwent endoscopies at Seoul National University Bundang Hospital between November 2011 and March 2013. H. pylori, AG and IM were evaluated, and pepsinogen I or II, I/II ratio, and interleukin (IL)-1β levels were measured.

Results: The mean pH of gastric juice was higher in the H. pylori-positive group (n=17) than that in the H. pylori-negative group (n=29) (4.54 vs 2.46, p=0.002). When patients were divided into pH ＜3 (n=28) and pH ≥3 (n=18) groups, H. pylori was lower in the pH ＜3 group (21.4%) than in the pH ≥3 group (61.1%) (p=0.007). The pH ≥3 group demonstrated AG and IM more frequently than the pH ＜3 group in the body (p=0.047 and p=0.051, respectively) but not in the antrum. There were no differences in pepsinogen I or II, I/II ratio, and IL-1β levels between the two groups.

Conclusions: There is a relationship between chronic H. pylori infection and gastric juice pH ≥3, which may originate from AG and IM in the body.

Keywords: Gastric juice; Gastritis, atrophic; Helicobacter pylori; Intestinal metaplasia.

Fig. 1

Diagram of study patient enrollment.

Fig. 2

Association between gastric juice acidity and Helicobacter pylori infection. (A) The H. pylori infection rate at pH <3 is 21.4%. (B) By contrast, the infection rate at pH ≥3 is 61.1%, which is statistically significant.

Fig. 3

Association between gastric juice acidity and atrophic gastritis. The presence of atrophic gastritis in the gastric antrum at pH <3 and pH ≥3 is 50.0% and 57.1%, respectively. The presence of atrophic gastritis in the gastric body for patients in the pH <3 and pH ≥3 groups with AG in the gastric antrum are 21.1% and 52.9%, respectively, which is statistically significant.

Fig. 4

Association between gastric juice acidity and moderate or severe intestinal metaplasia. The presence of moderate or severe intestinal metaplasia in the antrum in the pH <3 and pH ≥3 groups is 25.0% and 38.9%, respectively. The presence of moderate or severe intestinal metaplasia in the body in the pH <3 and pH ≥3 groups is 17.9% and 44.4%, respectively, which is statistically significant.