Low prevalence of H. pylori infection in patients with gastroparesis

The histopathology of the gastric mucosa in patients with gastroparesis, a condition characterized by gastric retention without obstruction, has not been described.

To test the hypothesis that reactive gastropathy is more common in patients with gastroparesis than in subjects with normal gastric motility.

We compared the prevalence of reactive gastropathy, Helicobacter pylori infection, chronic gastritis, and intestinal metaplasia in patients with and without a clinical diagnosis of gastroparesis extracted from a national database of subjects with gastric biopsies (1/2008-6/2012).

There were 3040 patients with gastroparesis (median age 58 years, 67.3% women) and 575,895 controls (median age 57 years, 62.0% women) with no evidence of gastroparesis. Reactive gastropathy was marginally more prevalent in patients with gastroparesis (18.9%) than in controls (17.0%). In contrast, H. pylori gastritis was present in 10.8% of controls, but only in 5.9% patients with gastroparesis (OR 0.52; 95% CI 0.45-0.61). Intestinal metaplasia was also less common in patients with gastroparesis (2.8% versus 3.9%; OR 0.82; 95% CI 0.58-0.89).

The low prevalence of H. pylori infection in gastroparesis could be explained by higher rates of previous eradication, conditions unfavourable to the survival of H. pylori, or a protective effect of mucosal inflammation against the development of motility disorders.