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. 1998 Sep;43(3):322–326. doi: 10.1136/gut.43.3.322

The relation between gastric vitamin C concentrations, mucosal histology, and CagA seropositivity in the human stomach

Z Zhang 1, S Patchett 1, D Perrett 1, P Katelaris 1, P Domizio 1, M Farthing 1
PMCID: PMC1727232  PMID: 9863475

Abstract

Background—Vitamin C may be protective against gastric cancer though infection with Helicobacter pylori is associated with a reduction in intragastric concentrations of vitamin C. 
Aims—To examine the effects of H pylori infection, gastric juice pH, the severity and extent of gastric inflammation, and CagA antibody status of the individual on gastric juice and mucosal vitamin C concentrations. 
Patients—One hundred and fifteen patients undergoing routine gastroscopy for investigation of dyspepsia. 
Methods—High performance liquid chromatography was used to determine vitamin C concentrations. CagA antibody was detected by western blot analysis. 
Results—Gastric juice ascorbic acid concentration was significantly lower in patients infected with H pylori compared with those uninfected (19.3 µmol/l (interquartile range (IQR) 10.7-44.5) versus 66.9 µmol/l (IQR 24.4-94.2), p=0.003). The reduction in gastric juice ascorbic acid concentration was inversely related to the severity of gastritis (p=0.01). CagA positive patients had significantly lower gastric juice ascorbic acid concentrations than CagA negative ones (14.8 µmol/l (IQR 7.9-52.2) versus 39µmol/l (IQR 19.9-142.2), p=0.05). Decreased gastric juice dehydroascorbic acid concentrations were observed in patients with gastric atrophy and intestinal metaplasia. Mucosal ascorbic acid concentrations were also significantly lower in infected patients than uninfected patients (p=0.04). 
Conclusions—The reduction in gastric vitamin C concentrations is related to gastric juice pH, the severity and extent of gastritis, the presence of H pylori, and the CagA antibody status of the individual. These findings may have implications in H pylori associated carcinogenesis. 



Keywords: ascorbic acid; Helicobacter pylori; gastric juice; gastric mucosa; premalignancy

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Figure 1 .

Figure 1

H pylori infection related to gastric juice ascorbic acid and DHA concentrations (Mann-Whitney U test).

Figure 2 .

Figure 2

CagA antibody status related to gastric juice ascorbic acid concentrations. (Mann-Whitney U test and Kruskal-Wallis one way ANOVA).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. An international association between Helicobacter pylori infection and gastric cancer. The EUROGAST Study Group. Lancet. 1993 May 29;341(8857):1359–1362. [PubMed] [Google Scholar]
  2. Banerjee S., Hawksby C., Miller S., Dahill S., Beattie A. D., McColl K. E. Effect of Helicobacter pylori and its eradication on gastric juice ascorbic acid. Gut. 1994 Mar;35(3):317–322. doi: 10.1136/gut.35.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blaser M. J., Perez-Perez G. I., Kleanthous H., Cover T. L., Peek R. M., Chyou P. H., Stemmermann G. N., Nomura A. Infection with Helicobacter pylori strains possessing cagA is associated with an increased risk of developing adenocarcinoma of the stomach. Cancer Res. 1995 May 15;55(10):2111–2115. [PubMed] [Google Scholar]
  4. Block G. Vitamin C and cancer prevention: the epidemiologic evidence. Am J Clin Nutr. 1991 Jan;53(1 Suppl):270S–282S. doi: 10.1093/ajcn/53.1.270S. [DOI] [PubMed] [Google Scholar]
  5. Correa P., Fontham E., Pickle L. W., Chen V., Lin Y. P., Haenszel W. Dietary determinants of gastric cancer in south Louisiana inhabitants. J Natl Cancer Inst. 1985 Oct;75(4):645–654. [PubMed] [Google Scholar]
  6. Crabtree J. E., Covacci A., Farmery S. M., Xiang Z., Tompkins D. S., Perry S., Lindley I. J., Rappuoli R. Helicobacter pylori induced interleukin-8 expression in gastric epithelial cells is associated with CagA positive phenotype. J Clin Pathol. 1995 Jan;48(1):41–45. doi: 10.1136/jcp.48.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Crabtree J. E., Farmery S. M., Lindley I. J., Figura N., Peichl P., Tompkins D. S. CagA/cytotoxic strains of Helicobacter pylori and interleukin-8 in gastric epithelial cell lines. J Clin Pathol. 1994 Oct;47(10):945–950. doi: 10.1136/jcp.47.10.945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Crabtree J. E., Taylor J. D., Wyatt J. I., Heatley R. V., Shallcross T. M., Tompkins D. S., Rathbone B. J. Mucosal IgA recognition of Helicobacter pylori 120 kDa protein, peptic ulceration, and gastric pathology. Lancet. 1991 Aug 10;338(8763):332–335. doi: 10.1016/0140-6736(91)90477-7. [DOI] [PubMed] [Google Scholar]
  9. Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985 Jan-Mar;4(1):87–90. doi: 10.1002/sim.4780040112. [DOI] [PubMed] [Google Scholar]
  10. Edgar J. A. Dehydroascorbic acid and cell division. Nature. 1970 Jul 4;227(5253):24–26. doi: 10.1038/227024a0. [DOI] [PubMed] [Google Scholar]
  11. Hansson L. E., Nyrén O., Hsing A. W., Bergström R., Josefsson S., Chow W. H., Fraumeni J. F., Jr, Adami H. O. The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med. 1996 Jul 25;335(4):242–249. doi: 10.1056/NEJM199607253350404. [DOI] [PubMed] [Google Scholar]
  12. Kyrtopoulos S. A. N-nitroso compound formation in human gastric juice. Cancer Surv. 1989;8(2):423–442. [PubMed] [Google Scholar]
  13. Mirvish S. S., Wallcave L., Eagen M., Shubik P. Ascorbate-nitrite reaction: possible means of blocking the formation of carcinogenic N-nitroso compounds. Science. 1972 Jul 7;177(4043):65–68. doi: 10.1126/science.177.4043.65. [DOI] [PubMed] [Google Scholar]
  14. Nomura A., Stemmermann G. N., Chyou P. H., Kato I., Perez-Perez G. I., Blaser M. J. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med. 1991 Oct 17;325(16):1132–1136. doi: 10.1056/NEJM199110173251604. [DOI] [PubMed] [Google Scholar]
  15. O'Connor H. J., Schorah C. J., Habibzedah N., Axon A. T., Cockel R. Vitamin C in the human stomach: relation to gastric pH, gastroduodenal disease, and possible sources. Gut. 1989 Apr;30(4):436–442. doi: 10.1136/gut.30.4.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Odum L., Andersen L. P. Investigation of Helicobacter pylori ascorbic acid oxidating activity. FEMS Immunol Med Microbiol. 1995 Feb;10(3-4):289–294. doi: 10.1111/j.1574-695X.1995.tb00046.x. [DOI] [PubMed] [Google Scholar]
  17. Parsonnet J., Friedman G. D., Vandersteen D. P., Chang Y., Vogelman J. H., Orentreich N., Sibley R. K. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991 Oct 17;325(16):1127–1131. doi: 10.1056/NEJM199110173251603. [DOI] [PubMed] [Google Scholar]
  18. Poydock M. E. Effect of combined ascorbic acid and B-12 on survival of mice with implanted Ehrlich carcinoma and L1210 leukemia. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1261S–1265S. doi: 10.1093/ajcn/54.6.1261s. [DOI] [PubMed] [Google Scholar]
  19. Poydock M. E., Harguindey S., Hart T., Takita H., Kelly D. Mitogenic inhibition and effect on survival of mice bearing L1210 leukemia using a combination of dehydroascorbic acid and hydroxycobalamin. Am J Clin Oncol. 1985 Jun;8(3):266–269. doi: 10.1097/00000421-198506000-00013. [DOI] [PubMed] [Google Scholar]
  20. Poydock M. E., Reikert D., Rice J., Aleandri L. Inhibiting effect of dehydroascorbic acid on cell division in ascites tumors in mice. Exp Cell Biol. 1982;50(1):34–38. doi: 10.1159/000163124. [DOI] [PubMed] [Google Scholar]
  21. Price A. B. The Sydney System: histological division. J Gastroenterol Hepatol. 1991 May-Jun;6(3):209–222. doi: 10.1111/j.1440-1746.1991.tb01468.x. [DOI] [PubMed] [Google Scholar]
  22. Rathbone B. J., Johnson A. W., Wyatt J. I., Kelleher J., Heatley R. V., Losowsky M. S. Ascorbic acid: a factor concentrated in human gastric juice. Clin Sci (Lond) 1989 Mar;76(3):237–241. doi: 10.1042/cs0760237. [DOI] [PubMed] [Google Scholar]
  23. Rokkas T., Papatheodorou G., Karameris A., Mavrogeorgis A., Kalogeropoulos N., Giannikos N. Helicobacter pylori infection and gastric juice vitamin C levels. Impact of eradication. Dig Dis Sci. 1995 Mar;40(3):615–621. doi: 10.1007/BF02064380. [DOI] [PubMed] [Google Scholar]
  24. Rood J. C., Ruiz B., Fontham E. T., Malcom G. T., Hunter F. M., Sobhan M., Johnson W. D., Correa P. Helicobacter pylori-associated gastritis and the ascorbic acid concentration in gastric juice. Nutr Cancer. 1994;22(1):65–72. doi: 10.1080/01635589409514332. [DOI] [PubMed] [Google Scholar]
  25. Schorah C. J., Sobala G. M., Sanderson M., Collis N., Primrose J. N. Gastric juice ascorbic acid: effects of disease and implications for gastric carcinogenesis. Am J Clin Nutr. 1991 Jan;53(1 Suppl):287S–293S. doi: 10.1093/ajcn/53.1.287S. [DOI] [PubMed] [Google Scholar]
  26. Sobala G. M., Crabtree J. E., Dixon M. F., Schorah C. J., Taylor J. D., Rathbone B. J., Heatley R. V., Axon A. T. Acute Helicobacter pylori infection: clinical features, local and systemic immune response, gastric mucosal histology, and gastric juice ascorbic acid concentrations. Gut. 1991 Nov;32(11):1415–1418. doi: 10.1136/gut.32.11.1415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Sobala G. M., Pignatelli B., Schorah C. J., Bartsch H., Sanderson M., Dixon M. F., Shires S., King R. F., Axon A. T. Levels of nitrite, nitrate, N-nitroso compounds, ascorbic acid and total bile acids in gastric juice of patients with and without precancerous conditions of the stomach. Carcinogenesis. 1991 Feb;12(2):193–198. doi: 10.1093/carcin/12.2.193. [DOI] [PubMed] [Google Scholar]
  28. Sobala G. M., Schorah C. J., Sanderson M., Dixon M. F., Tompkins D. S., Godwin P., Axon A. T. Ascorbic acid in the human stomach. Gastroenterology. 1989 Aug;97(2):357–363. doi: 10.1016/0016-5085(89)90071-1. [DOI] [PubMed] [Google Scholar]
  29. Sobala G. M., Schorah C. J., Shires S., Lynch D. A., Gallacher B., Dixon M. F., Axon A. T. Effect of eradication of Helicobacter pylori on gastric juice ascorbic acid concentrations. Gut. 1993 Aug;34(8):1038–1041. doi: 10.1136/gut.34.8.1038. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tanaka K., Wilks M., Coates P. J., Farthing M. J., Walker-Smith J. A., Tabaqchali S. Mycobacterium paratuberculosis and Crohn's disease. Gut. 1991 Jan;32(1):43–45. doi: 10.1136/gut.32.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]

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