Helicobacter pylori Infection and Gastric Function in Patients with Fundic Atrophic Gastritis ANTONIO TUCCI, MD,* LORIS POLI, MD,* GUIDO BIASCO, MD,* GIOYANNI F. PAPARO, MD,* CESARE TOSETTI, MD,* PIETRO FUSAROLI, MD,* VITTORIO SAMBRI, PhD,† MANUELA DONATI, MD,† WALTER GRIGIONI, MD,‡ ANTONIO M. MORSELLI LABATE, MD,* VINCENZO STANGHELLINI, MD,* and GIANCARLO CALETTI, MD* In the present study we evaluated the relation among histology, H. pylori, IgG to H. pylori, gastric emptying, and acid secretion in 43 patients with fundic atrophic gastritis. On the basis of gastric acid secretion, patients were divided into three subgroups: patients with preserved acid secretion (Group 1), patients with hypochlorhydria (Group 2), and patients with achlorhydria (Group 3). Fundic glandular atrophy was more severe in hypoachlorhydric patients than in those with preserved acid secretion (P  0.05 vs Group 2, P  0.005 vs Group 3). H. pylori colonization was found in 94% of patients in Group 1, in 61% of patients in Group 2, and in only 8% of patients in Group 3 (P  0.001 vs Group 1, P  0.05 vs Group 2). Conversely, serological positivity to H. pylori was high in all three subgroups of patients (100% in Group 1, 77% in Group 2, 92% in Group 3). Gastric emptying was delayed in atrophic patients, particularly in those with hypoachlorhydria. Our data suggest that fundic atrophic gastritis represents a possible end stage of H. pylori infection, characterized by a progressive disappearance of the bacterium and a progressive deterioration of gastric func- tions. KEY WORDS: atrophy; gastritis; Helicobacter pylori; gastric emptying; acidimetry. Nonautoimmune atrophic gastritis of the fundus (AGF) is a common finding essentially characterized by inflammation and glandular atrophy of fundic mu- cosa, in the absence of an evident autoimmune pro- cess involving the gastric mucosa. The prevalence of this condition in the general population reaches rates of 30–35% (1–6); it is age related (1, 2, 4, 5) and has different geographical distributions (7). The clinicopathological importance of AGF springs from its close association with gastric carcinoma (8 – 10). It has been estimated that the risk of gastric cancer in patients with fundic atrophy is about 4.5- fold compared to the risk in subjects without atrophy (11). Longitudinal population-based studies suggest that AGF represents the result of a slow stepwise progres- sion of superficial gastritis (8, 9, 12, 13), which begins in the antrum and moves proximally into the fundus (13, 14). Recent acquisitions support the hypothesis that Helicobacter pylori may represent the primum movens of the whole process (15–19), but the actual role of this microorganism has not yet been clarified. An important sequel of fundic atrophy is the dete- rioration of gastric function. It has been widely dem- Manuscript received November 2, 1998; accepted April 29, 1999. From the *Department of Internal Medicine & Gastroenterol- ogy, †Institute of Microbiology, and ‡Department of Pathology, Hospital S. Orsola-Malpighi, University of Bologna, Bologna, Italy. Address for reprint requests: Antonio Tucci, M.D., Department of Internal Medicine & Gastroenterology, S. Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy. Digestive Diseases and Sciences, Vol. 46, No. 7 (July 2001), pp. 1573–1583 1573 Digestive Diseases and Sciences, Vol. 46, No. 7 (July 2001) 0163-2116/01/0700-1573$19.50/0 © 2001 Plenum Publishing Corporation