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STOMACH |
1 University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
2 Biomedical Research Institute, University of Warwick, UK
Correspondence to:
Correspondence to:
Dr C U Nwokolo, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry CV2 2DX, UK;
chuka.nwokolo{at}uhcw.nhs.uk
ABSTRACT
Background: In the Western world, the incidence of oesophageal adenocarcinoma has increased over the last 30 years coinciding with a decrease in the prevalence of Helicobacter pylori. Trends of increasing oesophageal adenocarcinoma can be linked causally to increasing gastro-oesophageal reflux disease (GORD) which can be linked to an increasingly obese population. However, there is no plausible biological mechanism of association between H pylori, obesity, and GORD. Ghrelin, a peptide produced in the stomach, which regulates appetite, food intake, and body composition, was studied in H pylori positive asymptomatic subjects.
Methods: Plasma ghrelin, leptin, and gastrin were measured for six hours after an overnight fast, before and after cure of H pylori in 10 subjects. Twenty four hour intragastric acidity was also assessed.
Results: After cure, median (95% confidence intervals) integrated plasma ghrelin increased from 1160.5 (765.5–1451) pg/mlxh to 1910.4 (1675.6–2395.6) pg/mlxh (p=0.002, Wilcoxon’s rank sum test), a 75% increase. This was associated with a 14% increase in 24 hour intragastric acidity (p=0.006) and non-significant changes in leptin and gastrin. There was a significant positive correlation between plasma ghrelin and intragastric acidity (rs 0.44, p=0.05, Spearman’s rank correlation)
Conclusions: After H pylori cure, plasma ghrelin increased profoundly in asymptomatic subjects. This could lead to increased appetite and weight gain, and contribute to the increasing obesity seen in Western populations where H pylori prevalence is low. This plausible biological mechanism links H pylori, through increasing obesity and GORD, to the increase in oesophageal adenocarcinoma observed in the West.
Keywords: ghrelin; leptin; Helicobacter pylori; gastrin; gastric acidity; oesophageal adenocarcinoma
Abbreviations: OA, oesophageal adenocarcinoma; GORD, gastro-oesophageal reflux; CV, coefficient of variation; BMI, body mass index
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