{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:23:05Z","timestamp":1762176185169,"version":"3.44.0"},"reference-count":41,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1996,10]]},"abstract":"<jats:p>BACKGROUND: The presence of gastric metaplasia allows helicobacter pylori to colonise the duodenum and this condition is thought to be acquired as a response to acid hypersecretion. This functional disorder, however, is present only in a subgroup of duodenal ulcer patients and, in addition, surface gastric metaplasia has been frequently found in the proximal duodenum of normal subjects and patients with non-ulcer dyspepsia, who cannot be certainly considered as acid hypersecretors. AIMS: To clarify the role of acid in inducing gastric type epithelium in the duodenum. This study aimed at assessing whether the pattern of circadian gastric acidity differs between H pylori positive duodenal ulcer patients with and without duodenal gastric metaplasia. PATIENTS: Seventy one patients with duodenal ulcer confirmed by endoscopy and who were found to be positive for H pylori infection by histology on antrum biopsy specimens were enrolled into this study. METHODS: Gastric type epithelium in the duodenum was found in 49 of 71 ulcer patients (69%). Continuous 24 hour gastric pH metry was performed in 50 healthy subjects and in the two subgroups of duodenal ulcer patients with and without gastric metaplasia in the duodenum. Gastric acidity was calculated for 24 hours (1700-1659), night (2000-0759) and day-time (0800-1959). RESULTS: Ulcer patients without gastric metaplasia showed a significantly higher gastric acidity (p &lt; 0.001) than controls for every time interval considered, while the ulcer subgroup with gastric metaplasia was more acid than healthy subjects (p &lt; 0.001) during the whole 24 hour period and the daytime. There was no difference between the two subgroups of duodenal ulcer patients with and without gastric metaplasia during the various time segments analysed. CONCLUSION: The findings confirm that the circadian gastric acidity of duodenal ulcer patients is higher than that of controls. As there is no difference in gastric pH between duodenal ulcer patients with and without gastric metaplasia, gastric hyperacidity is not specific to patients with duodenal gastric metaplasia. It is probable that this histological change is a non-specific response to mucosal injury resulting from various factors and not exclusively to acid.<\/jats:p>","DOI":"10.1136\/gut.39.4.508","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"508-512","source":"Crossref","is-referenced-by-count":19,"title":["Circadian gastric acidity in Helicobacter pylori positive ulcer patients with and without gastric metaplasia in the duodenum."],"prefix":"10.1136","volume":"39","author":[{"given":"V","family":"Savarino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G S","family":"Mela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Zentilin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M R","family":"Mele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Lapertosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Patetta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Dallorto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Vassallo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Mansi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Vigneri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Celle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1056\/NEJM199104113241507","article-title":"Helicobacter pylori and peptic ulcer disease","volume":"324","author":"Peterson, W.L.","year":"1991","unstructured":"Peterson WL. 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Gut 1987; 28: 549-56.","journal-title":"Gut"},{"key":"ref_28","first-page":"1105","article-title":"Continuous acidity monitoring in the study of gastric antisecretory drugs: pH or antilog transformation of pH, mean or median?","volume":"85","author":"Mela, G.S.; Savarino, V.; SumberazA, Bonifacino; G, Zentilin; P, Villa; G.","year":"1990","unstructured":"Mela GS, Savarino V, SumberazA, Bonifacino G, Zentilin P, Villa G, et al. Continuous acidity monitoring in the study of gastric antisecretory drugs: pH or antilog transformation of pH, mean or median? Am J Gastroenterol 1990;85: 1105-8.","journal-title":"Am J Gastroenterol"},{"key":"ref_29","first-page":"961","article-title":"Optimizing the information obtained from continuous 24-hour pH monitoring","volume":"87","author":"Mela, G.S.; Savarino, V.; Vigneri, S.","year":"1992","unstructured":"Mela GS, Savarino V, Vigneri S. Optimizing the information obtained from continuous 24-hour pH monitoring. AmJr Gastroenterol 1992; 87: 961-6.","journal-title":"AmJr Gastroenterol"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1136\/gut.15.10.767","article-title":"Mucosal change in the human duodenum: a light and electron microscopic study and correlation with disease and gastric acid secretion","volume":"15","author":"Patrick, W.J.A.; Denham, D.; Forest, A.P.M.","year":"1974","unstructured":"Patrick WJA, Denham D, Forest APM. Mucosal change in the human duodenum: a light and electron microscopic study and correlation with disease and gastric acid secretion. Gut 1974; 15: 767-76.","journal-title":"Gut"},{"issue":"167","key":"ref_31","first-page":"16","article-title":"Chronic nonspecific duodenitis. A multiple biopsy study of the duodenal bulb in health and disease. ScandJ3 Gastroenterol","volume":"24","author":"Kreuning, J.; Wal, A.M.V.D.; Kuiper, G.; Lindeman, J.","year":"1989","unstructured":"Kreuning J, Wal AMVD, Kuiper G, Lindeman J. Chronic nonspecific duodenitis. A multiple biopsy study of the duodenal bulb in health and disease. ScandJ3 Gastroenterol 1989; 24 (suppl 167): 16-20."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00004836-199503000-00007","article-title":"Helicobacter pylori infection and gastric metaplasia in the duodenum in China","volume":"20","author":"Yang, H.; Dixon, M.F.; Zuo, J.; Fong, F.; Zhou, D.; Corthesy, I.","year":"1995","unstructured":"Yang H, Dixon MF, Zuo J, Fong F, Zhou D, Corthesy I, et al. Helicobacter pylori infection and gastric metaplasia in the duodenum in China. J Clin Gatroenterol 1995; 20: 110-2.","journal-title":"J Clin Gatroenterol"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1136\/gut.24.9.781","article-title":"Association between duodenal bulb ulceration and reduced exocrine pancreatic function","volume":"24","author":"Schulze, S.; Pedersen, N.T.; Jorgensen, M.J.; Mollman, K.M.; Rune, S.J.","year":"1983","unstructured":"Schulze S, Pedersen NT, Jorgensen MJ, Mollman KM, Rune SJ. Association between duodenal bulb ulceration and reduced exocrine pancreatic function. Gut 1983; 24: 781-3.","journal-title":"Gut"},{"key":"ref_34","first-page":"164","article-title":"Helicobacter pylori diminishes proximal duodenal musocal bicarbonate secretion in patients with duodenal ulcer disease","volume":"106","author":"Rapier, R.C.; Dreilinger, A.D.; Nyberg, L.M.; Koss, M.A.; Hogan, D.L.; Isenberg, J.I.","year":"1994","unstructured":"Rapier RC, Dreilinger AD, Nyberg LM, Koss MA, Hogan DL, Isenberg JI. Helicobacter pylori diminishes proximal duodenal musocal bicarbonate secretion in patients with duodenal ulcer disease. Gastroenterology 1994; 106: A164.","journal-title":"Gastroenterology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/0016-5085(87)90254-X","article-title":"Duodenal bulb acidity in patients with duodenal ulcer","volume":"93","author":"Bendtsen, F.; Rosenkilde-Gram, B.; Tage-Jensen, U.; Ovesen, L.; Rune, S.J.","year":"1987","unstructured":"Bendtsen F, Rosenkilde-Gram B, Tage-Jensen U, Ovesen L, Rune SJ. Duodenal bulb acidity in patients with duodenal ulcer. Gastroenterology 1987; 93: 1263-9.","journal-title":"Gastroenterology"},{"key":"ref_36","first-page":"61","article-title":"Duodenal bulb acidity and the natural history of duodenal ulceration","volume":"ii:","author":"Kerrigan, D.D.; Read, N.W.; Taylor, M.E.; Houghton, L.A.; Johnson, A.G.","year":"1989","unstructured":"Kerrigan DD, Read NW, Taylor ME, Houghton LA, Johnson AG. Duodenal bulb acidity and the natural history of duodenal ulceration. Lancet 1989; ii: 61-3.","journal-title":"Lancet"},{"key":"ref_37","first-page":"193","article-title":"Effect of Helicobacter pylori eradication on gastric metaplasia of the duodenum","volume-title":"Gut","volume":"36","author":"Khulusi, S.; Mendall, M.A.; Badve, S.; Patel, P.; Finlayson, C.; Northfield, T.C.","year":"1995","unstructured":"Khulusi S, Mendall MA, Badve S, Patel P, Finlayson C, Northfield TC. Effect of Helicobacter pylori eradication on gastric metaplasia of the duodenum. Gut 1995; 36: 193-7."},{"key":"ref_38","first-page":"78","article-title":"Gastric metaplasia in the duodenum and Campylobacter pylori","volume":"13","author":"Wyatt, J.I.; Rathbone, B.J.","year":"1989","unstructured":"Wyatt JI, Rathbone BJ. Gastric metaplasia in the duodenum and Campylobacter pylori. Gastroenterol Clin Biol 1989; 13: 78-82B.","journal-title":"Gastroenterol Clin Biol"},{"issue":"173","key":"ref_39","first-page":"1223","article-title":"Duplication of the rectum containing gastric mucosa","volume":"1960","author":"Stockman, J.M.; Young, V.T.; Jenkins, A.L.","unstructured":"Stockman JM, Young VT, Jenkins AL. Duplication of the rectum containing gastric mucosa. JAMA 1960; 173: 1223-5.","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1038\/343082a0","article-title":"Induction of a novel epidermal growth factor-secreting cell lineage by mucosal alteration in human gastrointestinal stem cells","volume":"343","author":"Wright, N.A.; Pike, C.; Elia, G.","year":"1990","unstructured":"Wright NA, Pike C, Elia G. Induction of a novel epidermal growth factor-secreting cell lineage by mucosal alteration in human gastrointestinal stem cells. Nature 1990; 343: 82-5.","journal-title":"Nature"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000198441","article-title":"Pathological and histomorphometric study of the effects of alcohol on the human duodenum","volume":"20","author":"Lev, R.; Thomas, E.; Parl, F.F.; Pitchumoni, C.S.","year":"1980","unstructured":"Lev R, Thomas E, Parl FF, Pitchumoni CS. Pathological and histomorphometric study of the effects of alcohol on the human duodenum. Digestion 1980; 20: 207-13.","journal-title":"Digestion"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.39.4.508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T19:10:44Z","timestamp":1757272244000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.39.4.508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,10]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1996,10,1]]},"published-print":{"date-parts":[[1996,10]]}},"alternative-id":["10.1136\/gut.39.4.508"],"URL":"https:\/\/doi.org\/10.1136\/gut.39.4.508","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[1996,10]]}}}