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Gut. 1999 April; 44(4): 468–475.
PMCID: PMC1727447

Helicobacter pylori infection potentiates the inhibition of gastric acid secretion by omeprazole


BACKGROUND—Omeprazole has a greater intragastric pH elevating effect in Helicobacter pylori positive than negative subjects. Ammonia production by H pylori has been suggested as a probable mechanism.
AIMS—To assess the effect of H pylori status on gastric acid secretion during omeprazole treatment, and to examine the possible role of ammonia neutralisation of intragastric acid in increased omeprazole efficacy in infected subjects.
METHODS—Twenty H pylori positive and 12 H pylori negative healthy volunteers were examined before and six to eight weeks after commencing omeprazole 40 mg/day. On both occasions plasma gastrin and acid output were measured basally and in response to increasing doses of gastrin 17 (G-17). Gastric juice ammonium concentrations were also measured.
RESULTS—Prior to omeprazole, measurements were similar in the H pylori positive and negative subjects. During omeprazole, median basal intragastric pH was higher in the H pylori positive (7.95) versus negative (3.75) subjects (p<0.002). During omeprazole basal, submaximal (180 pmol/kg/h G-17), and maximal acid outputs (800 pmol/kg/h G-17) were lower in H pylori positive subjects (0.0, 3.6, 6.0 mmol/h respectively) versus negative subjects (0.3,14.2, 18.6 mmol/h) (p<0.03 for each). This effect was not explained by neutralisation by ammonia.
CONCLUSION—The presence of H pylori infection leads to a more profound suppression of acid secretion during omeprazole treatment. The effect cannot be explained by neutralisation of intragastric acid by bacterial ammonia production and its precise mechanism has to be explained.

Keywords: omeprazole; Helicobacter pylori; ammonia; acid secretion

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Selected References

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Figures and Tables

Figure 1
Basal fasting gastric juice pH in H pylori negative and positive subjects before and during omeprazole treatment. Medians are represented by horizontal bars.
Figure 2
Basal plasma gastrin concentrations in the H pylori negative and positive subjects before and during omeprazole treatment. Medians are represented by horizontal bars.
Figure 3
Basal acid output in H pylori negative and positive subjects before and during omeprazole treatment. Medians are represented by horizontal bars.
Figure 4
Maximal acid output in the H pylori negative and positive subjects before and during omeprazole treatment. Medians are represented by horizontal bars.
Figure 5
Median acid outputs (and ranges) to the submaximal doses of G-17 in H pylori negative and positive subjects (A) before and (B) during omeprazole treatment.
Figure 6
Median plasma gastrin concentration versus median acid output curves for the H pylori negative and positive subjects before and during omeprazole treatment.

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