The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

The pathogenesis of hypergastrinaemia in MEN 1 and its relationship to Helicobacter Pylori infection (#214)

Ryan Endall 1 , Venkat Parameswaran 1 2 , John Burgess 1 2
  1. Department of Diabetes and Endocrinology, Royal Hobart Hospital, Tasmanian Health Service, Hobart, TAS, Australia
  2. School of Medicine, University of Tasmania, Hobart, TAS, Australia


Helicobacter pylori (H. Pylori) infection is typically acquired in the early decades of life and, if not cleared, is associated with gastritis and hypergastrinaemia [1]. Similarly, Multiple Endocrine Neoplasia Type 1 (MEN 1) predisposes gene carriers to a 30-40% risk of developing either hypergastrinaemia or overt Zollinger-Ellison Syndrome (ZES). Gastrinomas in MEN 1 are typically multifocal submucosal duodenal lesions. Further, H. Pylori incidence is augmented by the acid environment which prevails in MEN 1 and ZES.


To determine if a relationship exists between H. Pylori IgG seropositivity and hypergastrinaemia /ZES in MEN 1.


A retrospective longitudinal cohort study involving 99 individuals with MEN 1 who underwent fasting serum gastrin and H pylori serum IgG immunoassay assessment (mean age 43.9±17.9 years, 66.0% female). All patients were confirmed to have the Tasman 1 MEN1 gene mutation. ZES-range hypergastrinaemia was defined as gastrin >10-fold normal elevated.


Of the 99 patients tested for H pylori, 36 (36.4%) of cases were IgG seropositive. Serum gastrin was elevated greater than one-fold normal in 29 (80.6%), five-fold normal in 17 (47.2%) and ten-fold normal in 11 (30.6%) of the H pylori IgG positive patients. Of the 63 patients with negative H pylori serology, serum gastrin was elevated greater than one-fold normal in 30 (47.6%), five-fold normal in 6 (9.5%) and ten-fold normal in 2 (3.2%) patients. Of those patients with ZES-range serum gastrin elevation, 11 of 13 (85%) were H pylori IgG seropositive.


Severe hypergastrinaemia and ZES was strongly associated with H. Pylori seropositivity in this study. Chronic mild-moderate H. Pylori-related hypergastrinaemia may have the potential to stimulate pathogenesis of gastrinoma in MEN 1 by promoting neuroendocrine cell hyperplasia. This warrants further investigation.

  1. 1. Haruma, K. et al, Old and new gut hormone, gastrin, and acid suppressive therapy, Digestion, 2018. Vol. 97, No. 4, pp. 340-344