Journal Article

It is now recognized that there is a two-way interaction between Helicobacter pylori gastritis and gastric physiology. H. pylori gastritis can alter gastric physiology, leading to increased or decreased acid secretion depending on the pattern of gastritis present. These changes in physiology are related to the disease outcome, with increased acid secretion leading to duodenal ulcer disease and reduced acid secretion being a risk factor for gastric cancer. Gastric acid secretion also affects the pattern of gastritis induced by the infection, with low acid secretion leading to a pangastritis and possibly atrophy. This two-way interaction between H. pylori gastritis and acid secretion is likely to be involved in the evolution of the disease. It also can explain the more potent reduction of acid secretion produced by proton-pump inhibitors in H. pylori-positive subjects as well as rebound acid hypersecretion being more marked in H. pylori-negative subjects.