T1653 Helicobacter pylori Infection Is Less Likely in Patients with Inflammatory Bowel Disease: A Meta-Analysis of Relative Risk

Abstract

BACKGROUND: Nocturnal gastric acid breakthrough (NAB) often occurs during treatment with proton pump inhibitors (PPIs). The existence of NAB with resulting nocturnal acid reflux should be considered when patients with high-grade erosive gastroesophageal reflux disease show resistance to PPIs treatment. On the other hand, in some Helicobacter pylori (H. pylori)-positive subjects, intragastric pH spontaneously neutralizes during the middle of the night without any medication (nocturnal neutralizing of intragastric pH: NN). This probably results from the impairment of the gastric secretory function with the proximal extension of gastric mucosal atrophy. The existence of NN may be an important factor in the pathogenesis of NAB. AIMS: To predict the existence of NN by serum pepsinogen concentrations, relationships between pepsinogen concentrations and NN were investigated. METHODS: 239 subjects were enrolled. Intragastric pH was measured for 24-h, with no antisecretory treatment or antacid administration. NN was defined as intragastric pH > 6 continuously for two thirds or more of the middle-night period (22:00-06:00 h), therefore, subjects were classified into three groups according to the results; NN+: 66.7-100.0%, NN±: 33.4-66.6%, and NN−: 0-33.3%. H. pylori status and serum pepsinogen I and II concentrations were also investigated. Results were expressed as amedian (25th-75th percentile). RESULTS: Of the 125 H. pylori-positive subjects, 25 (20.0%) were NN+, 42 (33.6%) were NN±, and 58 (46.4%) were NN−. Serum pepsinogen I and the pepsinogen I/II ratios were 37.8 ng/mL (15.5-59.8 ng/mL) and 1.9 (0.9-2.6) in NN+, 59.8 ng/mL (48.0-96.3 ng/ mL) and 2.9 (2.4-3.7) in NN±, and 63.7 ng/mL (43.4-78.5 ng/mL) and 3.8 (3.3-4.4) in NN−, respectively. Nineteen of the NN+ subjects (76.0%), 17 NN± (40.5%), and 7 NN− (12.1%) were compatible with the serological atrophy-positive criterion; pepsinogen I ≦ 70 ng/mL and pepsinogen I/II ratio ≦ 3.0. Of the 43 subjects who were compatible with this criterion, 19 (44.2%) were NN+, whereas, of the 82 subjects who were not compatible, only 6 (7.3%) were NN+. On the other hand, of the 114 H. pylori-negative subjects, none was NN+, whereas 100 (87.7%) were NN−.None of the groups withoutH. pylori infection was compatible with this criterion.CONCLUSIONS: The NN phenomenon was only observed in H. pylori-positive subjects with serological gastric mucosal atrophy. Serum pepsinogen I and the pepsinogen I/II ratio could predict the existence of NN. In such subjects, stronger PPIs treatment to prevent NAB might be not necessary.